Adjunctive Balloon Dilatation Research Articles

Stent Optimization Using Adjunctive Balloon Dilatation in the Era of Second-Generation Drug-Eluting Stents

Stent Optimization Using Adjunctive Balloon Dilatation in the Era of Second-Generation Drug-Eluting Stents

Endovascular aortic aneurysm repair in patients with narrow aortas using bifurcated stent grafts is safe and effective

Narrowing of the distal aortic bifurcation can result in stent graft compression or arterial disruption during endovascular aortic aneurysm repair (EVAR). The aim of our study was to evaluate results of EVAR in patients with narrow distal aortic bifurcations. We reviewed the clinical data of 1070 patients who underwent EVAR between 2000 and 2011. Digital computed tomography angiograms were analyzed using centerline of flow measurements to determine aortic diameters. Patients with a distal aortic bifurcation diameter <18 mm were included in the study. End points were technical success, aortic disruption with retroperitoneal hemorrhage, stent graft complications (endoleaks, migration, sac enlargement, stenosis), reintervention, and iliac limb patency. EVAR was used to treat 112 patients (84 men and 28 women; mean age, 75 years) with aortic bifurcation <18 mm, including 34 (30%) who had diameter of <14 mm. Mean outer and inner aortic bifurcation diameter was 16 ± 3 and 14 ± 2 mm, respectively. Bifurcated stent grafts were used in 106 patients (95%). Six patients (5%) had planned aortouniiliac converters with femoral crossover graft. The aortic bifurcation was dilated after placement of bifurcated stent grafts using kissing balloon angioplasty in 80 patients (75%). All bifurcated stent grafts were successfully implanted, with no conversions to open repair or aortouniiliac converters. There were two early deaths (1.8%), and 12 patients (11%) developed early complications. No aortic disruptions or retroperitoneal hematomas occurred in the group treated with bifurcated grafts. After a median follow-up of 35 months, 11 patients (11%) treated by bifurcated stent grafts required reintervention to treat endoleak (n = 6) or iliac limb stenosis/occlusion (n = 5). One patient (17%) treated by aortouniiliac converter developed critical stenosis of an aortouniiliac graft limb, which was successfully treated with balloon angioplasty 29 months after the initial surgery. At 1 and 5 years, freedom from reintervention was 91% ± 3% and 84% ± 4%, respectively, for bifurcated stent grafts and 100% and 83% ± 10%, respectively, for aortouniiliac converters. Primary and secondary iliac limb patency was 98% ± 3% and 100%, respectively, for bifurcated stent grafts and 83% ± 10% and 100%, respectively, for aortouniiliac converters. EVAR with bifurcated stent grafts is safe and effective in patients with a narrow distal aortic diameter, even when the aortic bifurcation measures <14 mm. Adjunctive balloon dilatation did not result in any bleeding complications from aortic disruption, and limb patency was excellent. Aortouniiliac converters are rarely needed for this indication.

Photoablation Using theTurbo-Booster andExcimer Laser for In-Stent RestenosisTreatment: Twelve-Month Results From the PATENT Study

To evaluate the performance of the Turbo Elite laser catheter in combination with the Turbo-Booster guiding catheter for the treatment of femoropopliteal in-stent restenosis (ISR). The PATENT study (Photoablation Using the Turbo-Booster and Excimer Laser for In-Stent Restenosis Treatment) was a multicenter prospective industry-sponsored registry involving 5 European centers. Patients with symptomatic femoropopliteal ISR (Rutherford categories 2-5) and an ankle-brachial index ≤0.8 were treated with excimer laser atherectomy (ELA). Ninety patients (65 men; mean age 69.5±9.3 years) were enrolled. The majority of patients were Rutherford category 3 (63, 71.6%), and 32 (35.6%) patients had previous treatment for ISR. The average lesion length was 123±95.9 mm, and 30 (34.1%) lesions were total occlusions. The main efficacy outcome was primary patency at 12 months as measured by duplex ultrasonography. The primary safety outcome was freedom from major adverse events (MAE) during hospitalization and at 30-day follow-up to include all death, unplanned major amputation, or target lesion revascularization (TLR). The Turbo Elite laser catheter created a pilot channel in 87 (96.7%) of 90 lesions, with a mean of 1.5 passes, followed by the Turbo Booster with a mean of 5.7 passes. Adjunctive balloon dilation was performed in 79 (87.8%) lesions. Procedure success (<30% residual stenosis without stenting) was 96.7%. The mean percentage stenosis improved from a baseline of 87.0% to 32.3% after laser atherectomy and to 7.4% after final treatment. The MAE rate through 30 days was 2.2%. Nine (10.0%) patients experienced distal embolization. Estimates of freedom from TLR at 6 and 12 months were 87.8% and 64.4%, respectively. Primary patency at 6 and 12 months was 64.1% and 37.8%, respectively. Only a history of prior intervention for ISR (p<0.01) was a predictor of TLR at 12 months. The PATENT study has established excimer laser atherectomy as safe for the treatment of femoropopliteal ISR, achieving high procedure success. Recurrence of restenosis indicates that removing hyperproliferative tissue alone does not solve the problem of ISR. New concepts, such as the combination of ELA with drug-eluting balloons, may prove beneficial.

Behandlung von Instent-Reokklusionen der femoropoplitealen Arterien mit einem mechanischen Rotationskatheter

The main problem with the treatment of arterial stenoses by percutaneous transluminal angioplasty (PTA) or stent implantation is the relatively high restenosis rate. The objective of this prospective single-center study was to evaluate a mechanical rotational catheter (Straub Rotarex®) for its safety and efficacy in the treatment of in-stent reocclusions. 78 patients with a mean age of 64.2 ± 8.3 years (42 - 85) were treated by means of the Rotarex® catheter. All patients had in-stent reocclusions of the femoropopliteal arteries. The preinterventional Rutherford stage was on average 3.36 (2 - 5). The mean lesion length was 14.7 cm (6 - 30 cm). The ankle-brachial index (ABI) was determined prior to and after the intervention, as well as after 12 months. An additional follow-up was performed using color-coded duplex sonography. The technical success rate was 97.4 % (76 / 78). In 52 / 76 patients (68.4 %), adjunctive balloon dilation was performed, and 8 / 76 (10.5 %) patients required a stent implantation. Clinically, there was an increase in the ankle-brachial index from 0.61 ± 0.17 to 0.85 ± 0.15 post-interventionally. After 12 months, it was 0.78 ± 0.16, and the average Rutherford stage fell to 1.65 (1 - 3). During the follow-up observation period, there were 14 (18.4 %) restenoses. Two dissections after Rotarex were recorded as peri-interventional complications. No distal embolizations were observed. There were no amputations or deaths during the entire period of the study. The recanalization of in-stent reocclusions of femoropopliteal arteries using the Rotarex® system is safe and effective. The low rate of restenosis at 12 months appears to be promising.

Treatment of Chronic Occlusions of the Iliac or Femoropopliteal Arteries with Mechanical Rotational Catheters

The main problem with treating chronic lesions with percutaneous transluminal angioplasty (PTA) or stent implantation is the relatively high restenosis rate. The objective of this prospective single-center study was to evaluate a mechanical rotational catheter (Straub Rotarex®) for its safety and efficacy in the treatment of chronic vascular occlusions. There were 40 patients with a mean age of 67.3 ± 7.6 years (51 - 86) treated by means of the Rotarex® catheter. All patients had chronic occlusions (> 6 months) of the iliac (n = 4) or femoropopliteal arteries (n = 36). The preinterventional Rutherford stage was on average 3.15 (2 - 5). The mean lesion length was 12.3 cm (2 - 24 cm). The ankle-brachial index (ABI) was determined prior to and after the intervention, as well as after 12 months. An additional follow-up was performed using color-coded duplex sonography. The technical success rate was 100 %. In 27 patients (67.5 %), adjunctive balloon dilation was performed, and 7 (17.5 %) patients required a stent implantation. Clinically, there was an increase in the ankle-brachial index from 0.57 ± 0.15 to 0.82 ± 0.16 post-interventionally. After 12 months, it was 0.80 ± 0.12, and the average Rutherford stage fell to 1.65 (1 - 3). During the follow-up observation period, there were 9 (22.5 %) restenoses. Two dissections after balloon dilatation were recorded as peri-interventional complications. No distal embolizations were observed. There were no amputations or deaths during the entire period of the study. The atherectomy of lesions of the iliac and femoropopliteal arteries using the Rotarex® system is safe and effective. The low rate of peri-interventional stenting and the low rate of restenosis at 12 months appear to be promising.

Novel stent and delivery systems for the treatment of bifurcation lesions: porcine coronary artery model

In percutaneous treatment of bifurcation coronary lesions, side-branch restenosis remains a significant limitation in current therapeutic approaches. Coronary stents with a side aperture and a sleeve may be clinically advantageous to maintain access to side branch, stabilize the side-branch orifice, and deliver the appropriate drug to the side-branch ostium. A novel stent system (PETAL stent; Advanced Stent Technologies, Pleasanton, CA), incorporating a side aperture with deployable struts, was compared within porcine coronary model to the prior stent version having only the side aperture (SLK-View stent). In six pigs, each stent was implanted either in the left anterior descending coronary artery or the left circumflex coronary artery with adjunctive kissing balloon dilatation. At 28-day follow-up, coronary angiography was performed. A total of six SLK-View stents and six PETAL stents were implanted in coronary arteries without any complication, and adjunctive kissing balloon dilatations were successful in all lesions. Quantitative coronary angiography (QCA) data at 28 days showed that PETAL stents exhibited superior QCA in mean diameter compared with SLK-View stents for side branch, inferring efficacy of PETAL ostial struts. AST-PETAL stent has the potential to be a new solution for treatment of bifurcation lesions. Antirestenosis drug elution should be considered with this successful platform.

Randomized trial of Rotational Atherectomy Versus Balloon Angioplasty for Diffuse In-stent Restenosis (ROSTER)

BackgroundVarious autopsy and intravascular ultrasound (IVUS) studies have shown neointimal proliferation as the main mechanism of in-stent restenosis (ISR) responsible for >95% of luminal narrowing while stent struts are not compressed. ISR of diffuse type has a high incidence of recurrence (up to 70%) after balloon angioplasty (PTCA). Tissue ablation with percutaneous rotational coronary atherectomy (PRCA) may be more efficacious compared to tissue compression or extrusion after PTCA for the interventional treatment of diffuse ISR. MethodsThe Rotational Atherectomy Versus Balloon Angioplasty for Diffuse In-Stent Restenosis (ROSTER) trial is a single-center, randomized trial comparing PRCA to PTCA (both with IVUS guidance) in the treatment of diffuse ISR in 200 patients. In the PRCA group (n = 100), rotablation was performed using a burr-to-artery ratio >0.7 followed by adjunctive balloon dilatation at low pressure (4–6 atm). In the PTCA group (n = 100), high-pressure (>12 atm) balloon dilatation was performed using an optimal size balloon. The study's primary end point was target lesion revascularization (TLR) at 9 months and secondary end points included clinical events at 1 year and angiographic restenosis in a substudy of the last 75 patients enrolled. ResultsBaseline clinical and angiographic variables were comparable between the 2 groups with similar procedural and angiographic success, but a higher rate of repeat stenting occurred in the PTCA group (31% vs 10%; P <.001). Although the angiographic acute luminal gain was similar between the 2 groups, IVUS analysis revealed lower residual intimal hyperplasia area after PRCA versus PTCA (2.1 ± 0.9 mm2 vs. 3.3 ± 1.8 mm2; P = .005). At a mean follow-up of 12 ± 2 months, there were 2 deaths, 3 myocardial infarctions, and 3 coronary artery bypass graft procedures in each group. TLR incidence was 32% in the PRCA group and 45% in the PTCA group (P = .042), with a similar trend noted in the angiographic substudy. ConclusionThe ROSTER trial for diffuse ISR revealed both PRCA and PTCA to be safe and effective, but PRCA resulted in less residual intimal hyperplasia, lower repeat stent use, and decreased TLR.

Preliminary experience with the Xtrak debulking device in the treatment of peripheral occlusions.

To report our initial experience with a new rotary debulking device designed for treating long, diffusely diseased arterial segments. Ten symptomatic patients (8 men; mean age 63 years, range 34-76) with occluded superficial femoral (n = 6) or popliteal (n = 4) arteries were enrolled into a study to evaluate the debulking capabilities of a rotational atherectomy device. Occlusion length ranged from 4.0 to 16.1 cm (mean 11.1 +/- 4.10). The occlusions were treated with a low-speed, over-the-wire rotary device featuring a flexible, spiral "corkscrew" that embeds itself in the obstructive material while a rotary cutting catheter simultaneously cuts and captures the obstruction in a single pass. The device cut and retrieved material in a single pass from all segments without device-related complications. The captured material consisted of a mixture of atherosclerotic plaque and thrombus. Minimum lumen diameters (MLD) increased from 0.0 to 2.2 +/- 1.09 mm (p<0.05) after Xtrak treatment and to 4.09 +/- 1.20 mm (p<0.05) after adjunctive balloon dilation, which was used in 8 of 10 segments. All patients improved clinically after the procedure, with an increased the mean ankle-brachial index sustained at 6 months (0.69 +/- 0.32, p<0.05 compared to baseline and 1-month measurements). Six months after the procedure, 7 patients remained free of clinical symptoms, while 3 patients required a subsequent intervention. These initial results demonstrate that the Xtrak device can safely debulk long segments of diffusely diseased arteries in a single pass while simultaneously retrieving the occluding material. Supplementary angioplasty may be required in the majority of cases. Larger studies are required to determine whether debulking followed by balloon dilation improves the long-term prognosis in patients with chronic lower limb occlusions.

Efficacy of postdeployment balloon dilatation for current generation stents as assessed by intravascular ultrasound

Adjunctive balloon dilatation strategy has been shown to improve optimal stent deployment. As improvements in current stent designs evolve, less adjunctive balloon dilatation may be needed. However, few data currently exist to support this practice. We evaluated 88 native coronary lesions treated with single stent implantation (Nir, Tristar or S670). Serial intravascular ultrasound was performed after successful stent deployment and again after adjunctive balloon dilatation. To investigate further the precise expansion characteristics of the stents, serial volumetric intravascular ultrasound analyses were performed in 40 patients with automated pullback. After adjunctive balloon dilatation, minimal stent area increased significantly, from 6.4 ± 2.1 to 7.4 ± 2.2 mm 2 (p <0.001). Volumetric analysis showed a corresponding increase in stent volume index (6.6 ± 1.8 to 7.5 ± 2.0 mm 3/mm, p <0.001). In the analysis of cross sections at 0.5-mm axial intervals, the percentage of cross sections, where stent area was ≥80% of the average reference lumen area, increased from 51% to 78% (p <0.001). Similarly, the percentage of cross sections, where stent area was ≥90% of the average reference lumen area, increased from 29% to 56% (p <0.001) with postdilatation. Postdeployment high- pressure balloon dilatation improved minimal stent area and volumetric expansion throughout the stented segment.

Excimer Laser Angioplasty with Adjunctive Balloon Dilatation Versus Balloon Dilatation Alone for the Treatment of In‐Stent Restenosis: Results of a Randomized Single‐Center Study

Background: Laser ablation of neointimal tissue prior to balloon dilatation has been shown to be a potential treatment modality for restenosis within previously implanted stents. It remains controversial whether this treatment provides superior acute and long‐term results compared to conventional balloon dilatation. Methods and Results: Between November 1995 and November 1996, 96 patients with significant (≥ 50%) in‐stent restenosis were randomized to receive excimer laser angioplasty with adjunctive balloon dilatation (ELCA + PTC A, n = 47) or PTCA alone (n = 49). Both groups did not differ with regard to gender, clinical history, location of the lesion, reference diameter, or lesion length. Angiographic success was achieved in 46 patients with ELCA + PTCA (98%) and in 48 patients with PTCA alone (98%). In‐hospital complications included acute closure in one patient of each group, one CABG, one repeat PTCA, and one non‐Q wave MI with ELCA + PTCA, versus two bleeding and one death with PTCA. Clinical follow‐up was obtained in all patients, while angiographic follow‐up was available in 35 of 47 (ELCA+PTCA) versus 35 of 49 (PTCA) patients with a mean follow‐up time of 163 ± 81 days. With ELCA+PTCA, MLD increased from 0.82 ± 0.38 to 1.99 ± 0.33 mm versus 0.81 ± 0.39 mm to 2.07 ± 0.60 mm with PTCA (P = NS). At follow‐up, MLD was 1.32 ± 0.60 mm with ELCA + PTCA versus 1.45 ± 0.75 mm with PTCA (P = NS). Late adverse events included nine repeat PTCA with ELCA +PTCA (19%) versus 12 with PTCA (24%), three CABG with ELCA +PTCA (6%) versus two with PTCA (4%), and one death (2%) with PTCA (P = NS). Angiographic restenosis rate was 52% with ELCA + PTCA versus 47% with PTCA alone (P = NS). Conclusion: Our data suggest that excimer laser angioplasty with adjunctive balloon dilatation for the treatment of in‐stent restenosis provides similar acute results as plain balloon dilatation and may offer no advantage over PTCA alone with regard to intermediate‐term outcomes.

Rotational Ablation With Adjunctive Low-Pressure Balloon Dilatation in Diffuse In-stent Restenosis: Immediate and Follow-up Results

Rotational Ablation With Adjunctive Low-Pressure Balloon Dilatation in Diffuse In-stent Restenosis: Immediate and Follow-up Results

The role of adjunctive balloon dilatation in directional coronary atherectomy without subintimal resection

The role of adjunctive balloon dilatation in directional coronary atherectomy without subintimal resection

The Role of Adjunctive Balloon Dilatation in Directional Coronary Atherectomy Without Subintimal Resection

The Role of Adjunctive Balloon Dilatation in Directional Coronary Atherectomy Without Subintimal Resection

Rotational ablation with adjunctive low-pressure balloon dilatation in diffuse in-stent restenosis: immediate and follow-up results

Rotational ablation with adjunctive low-pressure balloon dilatation in diffuse in-stent restenosis: immediate and follow-up results

Angioscopy variables predictive of early angiographic outcome after excimer laser-assisted coronary angioplasty

This study attempted to determine whether anatomic findings at angioscopy were associated with adverse early angiographic outcomes following excimer laser-assisted coronary angioplasty. Predictive factors of either coronary abrupt vessel closure or early (≤24 hours) restenosis after percutaneous coronary angioplasty, including clinical and angiographic variables, have been widely evaluated. The role of angioscopic findings may contribute to identification of patients at risk for early poor outcome. Thirty-seven patients with severe lesions, including 23 total occlusions which underwent successful percutaneous transluminal coronary angioplasty (PTCA) with laser irradiation and adjunctive balloon dilatation (n = 35), or stand alone laser (n = 2), had concomitant angioscopic imaging of the target vessel. All patients had a 24-hour angiographic follow up. Early unfavorable outcome (n = 15) was defined as abrupt vessel closure or restenosis (≥50% stenosis) at 24 hours. By multivariate logistic regression analysis, immediate post-PTCA residual percent stenosis was associated with a poor outcome (restenosis: 33 ± 22% vs no restenosis: 21 ± 14%, p = 0.05). Angioscopic red thrombus aspect was the most significant correlate for early closure or restenosis (7 of 15 patients with unfavorable outcome vs 2 of 22 patients with favorable outcome, odds ratio, 22.9; p < 0.01) and was associated with a significantly higher early minimal lumen diameter loss (1 ± 0.8 mm in the presence of a red thrombus vs 0.3 ± 0.5 mm without thrombus, p < 0.005). Red thrombus appearance is associated with an unfavorable early angiographic outcome in patients who undergo laser-assisted coronary angioplasty.

Recanalization of chronic coronary occlusions using a laser wire.

Between August, 1993-December, 1994, recanalization of a chronically occluded coronary artery was attempted in 412 patients, with an overall success rate of 77%. The main reason for failure was subintimal tracking of the guide wire. However, in 13 patients, advancing the guide wire was not possible either subintimally or in the former true lumen. In 8 of these 13 patients with failed conventional recanalization, a second attempt was made using a 0.018" laser wire. The suspected occlusion duration was 6 wk-6 yr, and the occlusion length 6-21 mm. Successful crossing of the occlusion was achieved in 7 of 8 patients. One patient experienced pericardial hematoma without severe clinical consequences. Adjunctive conventional laser angioplasty and/or balloon dilatation led to a residual stenosis of < 50% in 7 patients. The laser wire technique may become an important new method for recanalizing chronic total coronary occlusions in selected patients.

Immediate and late outcome of excimer laser and balloon coronary angioplasty: A quantitative angiographic comparison based on matched lesions

This study sought to compare acute lumen changes and late lumen narrowing during and after excimer laser-assisted balloon angioplasty, measured by quantitative coronary angiography, with the immediate and long-term outcome of balloon angioplasty alone. Although excimer laser coronary angioplasty is used as an adjunct or alternative to balloon angioplasty, limited comparative data exist regarding the immediate and long-term efficacy of excimer laser-assisted balloon angioplasty versus balloon angioplasty alone. A series of 53 lesions in 47 consecutive patients successfully treated with excimer laser-assisted balloon angioplasty were individually matched after completion of 6-month follow-up angiography with 53 successfully treated balloon angioplasty lesions according to vessel location, preprocedural minimal lumen diameter and reference diameter. Immediate and long-term angiographic results were assessed by an automated lumen contour detection algorithm. Before intervention in the laser and balloon angioplasty groups, respectively, minimal lumen diameter (mean +/- SD) was 0.73 +/- 0.47 and 0.74 +/- 0.46 mm, and reference diameter was 2.71 +/- 0.42 and 2.72 +/- 0.41 mm. Laser angioplasty was followed by adjunctive balloon dilation in 50 lesions. Mean balloon diameter at maximal inflation was similar in both treatment groups (2.61 +/- 0.32 and 2.65 +/- 0.38 mm, respectively), resulting in similar minimal lumen diameters after intervention of 1.77 +/- 0.41 and 1.78 +/- 0.34 mm, respectively. At follow-up angiography, minimal lumen diameter after excimer laser-assisted balloon angioplasty was 1.17 +/- 0.63 mm, and that after balloon angioplasty alone was 1.46 +/- 0.67 mm (p = 0.02). The angiographic restenosis rates at follow-up using the 50% diameter stenosis cutoff criterion were 57% and 34%, respectively (p = 0.02). Quantitative angiographic analysis of a matched group of 106 successfully treated coronary lesions showed a similar immediate outcome but reduced long-term efficacy of excimer laser-assisted balloon angioplasty compared with that after balloon angioplasty alone.

Quantitative angiographic comparison of elastic recoil after coronary excimer laser-assisted balloon angioplasty and balloon angioplasty alone

Objectives. Coronary lumen changes during and after excimer laser-assisted balloon angioplasty were measured by quantitative coronary angiography, and the results were compared with the effects of balloon angioplasty alone.Background. Reduction of atherosclerotic tissue mass by laser ablation in the treatment of coronary artery disease may be more effective in enlarging the lumen than balloon angioplasty alone.Methods. A series of 57 consecutive coronary lesions successfully treated by xenon chloride excimer laser-assisted balloon angioplasty were individually matched with 57 coronary artery lesions successfully treated by balloon angioplasty alone. The following variables were measured by quantitative coronary analysis: 1) ablation by laser, 2) stretch by balloon dilation, 3) elastic recoil, and 4) acute gain.Results. Matching by stenosis location, reference diameter and minimal lumen diameter resulted in two comparable groups of 57 lesions with identical baseline stenosis characteristics. Minimal lumen diameter before excimer laser-assisted balloon angioplasty and balloon angioplasty alone were (mean ± SD) 0.73 ± 0.44 and 0.74 ± 0.43 mm, respectively. Laser ablation significantly improved minimal lumen diameter by 0.56 ± 0.44 mm before adjunctive balloon dilation. In both treatment groups, similar-sized balloon catheters (2.59 ± 0.35 and 2.56 ± 0.40 mm, respectively) were used. After laser-assisted balloon angioplasty, elastic recoil was 0.84 ± 0.30 mm (32% of balloon size), which was identical to that after balloon angioplasty alone, namely, 0.82 ± 0.32 mm (32%). Consequently, both interventions resulted in similar acute gains of 1.02 ± 0.52 and 1.00 ± 0.56 mm, respectively. Minimal lumen diameter after intervention was equal in both groups: 1.75 ± 0.35 and 1.75 ± 0.34 mm, respectively. The statistical power of this study in which a 25% difference in elastic recoil (0.2 mm) between groups was considered clinically important was 95%.Conclusions. In matched groups of successfully treated coronary lesions, xenon chloride excimer laser ablation did not reduce immediate elastic recoil after adjunctive balloon dilation or improve the final angiographic outcome compared with balloon angioplasty alone using similar-sized balloon catheters.

Comparison of Early Recoil after Coronary Excimer Laser Angioplasty with and without Adjunctive Balloon Dilatation

The immediate and early angiographic results in lesions treated solely with percutaneous coronary excimer laser angioplasty were compared with those obtained after combined laser and balloon angioplasty to determine whether early recoil may occur after coronary excimer laser angioplasty. The excimer laser was operated at 308 nm, 25 Hz, 40–60 mJ/mm2/pulse and 135 nsec/pulse and coupled onto multifiber wire‐guided catheters of 1.4‐ to 2.0‐mm diameter. Thirty‐five consecutive patients (32 men and 3 women; mean age 56 ± 8 years) were studied. Ten patients were treated with laser angioplasty alone (group I), and 25 patients were treated using laser angioplasty followed by balloon dilatation (group II). In group I, the minimal luminal diameter increased from 1.89 ± 0.50 mm immediately after the procedure to 2.17 ± 0.51 mm at the early follow‐up (P &lt; 0.01), whereas in group II, the minimal luminal diameter decreased from 1.89 ± 0.45 mm to 1.50 ± 0.60 mm (P &lt; 0.005). At the early follow‐up, the minimal luminal diameter of group II was significantly smaller than that of group I (1.50 ± 0.60 vs 2.17 ± 0.51 mm; P &lt; 0.05). These data demonstrate that coronary excimer laser angioplasty alone results in less severe early recoil than adjunctive balloon angioplasty. (J Interven Cardiol 1994; 7:221–228)

Percutaneous laser recanalisation of femoropopliteal occlusions using continuous wave Nd-YAG laser and sapphire contact probe delivery system

A conventional continuous wave Nd-YAG medical laser system delivered by transparent sapphire tipped optical fibres was used for percutaneous recanalisation of 32 chronic femoropopliteal occlusions in 27 patients (19 men, eight women; median age 68 years, range 46-83 years). Twenty-four patients had severe intermittent claudication and three had critical ischaemia. The median occlusion length was 8 cm (range 3-35 cm) and lesions were not negotiable by guidewire. Laser energy was delivered at powers of 10-15 Watts using intermittent 1 second emissions (mean total energy 315 Joules, range 30-1015]). The sapphire tips used were 1.8 to 3.0 mm diameter. After laser recanalisation adjunctive balloon dilatation was necessary to widen the resulting lumen. All patients received anti-platelet therapy. Initial clinical success was achieved in 22 limbs (69%) with symptomatic relief and increase in mean (+/- S.D.) ankle-brachial pressure ratio from 0.52 (+/- 0.25) to 0.80 (+/- 0.21) [Mann-Whitney U, p < 0.001]. Recanalisation was unsuccessful in all calcified lesions (four cases). There was a high incidence of vessel perforation (28%) and wall dissection (25%). Emergency surgery was not required after failed procedures. The median follow-up was 12 months (range 6-20 months). By 6 months, 15 of 22 successfully recanalised lesions (68%) had reoccluded. The cumulative primary patency at 1 year was only 12%. These disappointing results do not support routine use of this system. Clearly, modifications of the laser/delivery system or the technique, or both, are required. The aim should be to achieve sole laser recanalisation without concomitant balloon dilatation.