Dissections Following Excimer Laser‐Assisted Angioplasty of Saphenous Vein Bypass Grafts: Analysis of Incidence and Effect of Adjunctive Balloon Angioplasty

Abstract

Excimer laser angioplasty, when first developed for the treatment of coronary artery disease, appeared promising based on preliminary work suggesting minimal vessel wall damage with excimer laser ablation. The excimer laser has since been used in the treatment of bulky, saphenous vein graft (SVG) lesions. To investigate the significance of the laser‐vessel wall interaction, we studied the incidence of laser‐induced dissections as well as the effect of adjunctive balloon angioplasty, in a multicenter trial of 188 SVG lesions undergoing CVX‐JOO™ excimer laser ablation. Adjunctive balloon angioplasty was performed at the discretion of the individual operators. Laser‐induced dissections were angiographically evident in 78 (41%) of 188 SVG lesions following laser ablation. Most of these were mild (National Heart, I.ung, and Blood Institute [NHLBIJ A or B). Adjunctive balloon angioplasty was performed following 73% of laser ablations and tended to improve the severity of laser‐induced dissections, including the successful recanalization of 7 of 9 laser‐induced total occlusions. Of the 117 SVG lesions with either no dissection or only mild dissection (NIILBI A or B), only 4 worsened to a moderate or severe (NHLBl C‐F) status after adjunctive balloon angioplasty. Vessel wall injury, manifested as dissection, frequentlv occurs following excimer laser angioplasty of SVG lesions. Most of these dissections are angio‐graphicaliy mild, and, when severe, are effectively reduced by adjunclive balloon angioplasty. Further techniques, such as multiplex catheters or saline infusion, aimed at minimizing vessel wall injury from laser ablation, may be required to reduce the occurrence of laser‐induced dissections.