RECANALIZATION OF CHRONIC TOTAL CORONARY OCCLUSIONS USING A LASER GUIDE-WIRE - A PILOT-STUDY

Objectives. This study sought to prospectively evaluate the performanc e of a laser guide wire in crossing chronic total coronary occlusions in patients with a failed previous mechanical guide wire attempt. Back ground. Despite continued refinement of mechanical hardware available for coronary angioplasty, restoration and maintenance of blood bow thr ough a chronically occluded coronary artery remains a true challenge. Methods. Fifty patients with a chronic total coronary occlusion and a previous failed attempt at recanalization using mechanical guide wires were included. A mechanical attempt to cross the occlusion was repeat ed. In case of failure, an additional attempt was made with the laser guide wire. Results. The median age of occlusion was 22 weeks (range 5 to 200), and the occlusion length was 23 +/- 11 mm (mean +/- SD). A r epeat mechanical attempt was successful in six cases (12%). Dissection occurred in five other cases, and device crossover was not attempted. Thus, in 39 patients an attempt was made with the laser guide wire, w ith successful recanalization in 23 (59%). Thereby the overall success rate increased from 12% to 58% (29 of 50 patients). The amount of con trast medium used was 515 +/- 154 ml, fluoroscopy time was 99 +/- 43 m in, and total procedure time was 2 h 48 min (+/-55 min). Procedural su ccess was achieved in 26 cases and clinical success (procedural succes s without in hospital events) in 24. In-hospital events were two non-Q wave myocardial infarctions related to subacute reocclusion. In one p atient, a balloon dilation after laser guide wire perforation resulted in tamponade requiring pericardiocentesis. After a successful procedu re, the angina class decreased from 2.9 +/- 0.2 to 1.4 +/- 0.7 at 3 mo nths of clinical follow-up. Six month angiographic follow-up was compl eted in all 24 eligible patients and showed vessel patency in 20 (80%) . Conclusions. The use of the laser guide wire for recanalization of c hronic total coronary occlusions refractory to treatment with mechanic al guide wires is feasible and relatively safe and was successful in 5 9% of cases, This device must thus be considered a valuable addition t o the interventional armamentarium and accordingly will be evaluated i n a randomized clinical trial. (C) 1997 by the American College of Car diology.