Adjunctive Balloon Dilatation Research Articles

Analysis of late lumen narrowing after excimer laser-facilitated coronary angioplasty

Objectives. The purpose of this study was to analyze the quantitative angiographic factors affecting restenosis after excimer laser-facilitated coronary angioplasty.Background. Restenosis after balloon angioplasty, directional atherectomy and coronary stenting has been analyzed using both dichotomous (≥ 50% diameter stenosis) and continuous (late lumen narrowing) end points, leading to the conclusion that achieving a large lumen diameter at the time of the procedure is associated with a lower risk of angiographic restenosis.Methods. Quantitative angiographic measurements were made before treatment, after laser angioplasty, after adjunctive balloon angioplasty and at 6-month angiographic follow-up in 168 patients with 179 treated lesions.Results. The immediate increase in lumen diameter (total acute gain 1.45 ± 0.71 mm [mean ± SD]) was due to the combination of laser treatment (0.79 ± 0.61 mm) and subsequent adjunctive balloon angioplasty (0.66 ± 0.55 mm). At follow-up, the minimal lumen diameter had decreased (late loss 0.71 ± 0.84 mm), yielding an overall restenosis rate of 50% (defined dichotomously by ≥ 50% diameter stenosis). Multivariable regression analyses showed that restenosis was related to vessel diameter, as well as minimal lumen diameter, achieved immediately after the proceure.Conclusion. Although the restenosis rales for the small vessels typically treated with excimer laser angioplasty were high, the lowest restenosis rates were seen to large vessels with the largest postprocedural minimal lumen diameters. The goal of this procedure should be to safely achieve the largest lumen possible with the combination of laser treatment and adjunctive balloon dilation.

Excimer laser coronary angioplasty in the Netherlands: Preamble for a randomized study

The immediate outcome of ELCA by XeCl excimer laser radiation is described in 53 patients who were selected to undergo ELCA from December 1990 to September 1991 in two centers that are currently performing ELCA in the Netherlands. Immediate success rates on the basis of visual assessment of the angiogram were as follows. Laser success (>20% reduction of diameter stenosis after ELCA alone) was observed in 77% of patients, procedural success (<50% residual stenosis after ELCA with or without adjunctive balloon dilatation [PTCA]) in 91%, and clinical success (procedural success without clinical complications) in 83% of patients. Quantitative coronary angiography by automated contour detection was performed in 31 patients who underwent ELCA in the Thoraxcenter. The minimal luminal diameter (mean ± SD) of the treated coronary segments increased from 0.77 ± 0.41 mm to 1.24 ± 0.25 mm after ELCA and further to 1.67 ± 0.29 mm after adjunctive PTCA in 25 patients. The present experience is put in perspective of results initially reported by other centers and compared with data from multicenter registries of ELCA. Finally, a short description is given of the design of a prospective, randomized trial of ELCA versus conventional PTCA (AMRO trial).

Reliability of quantitative coronary angiography of the target lesion immediately and 1 day after coronary balloon and excimer laser angioplasty

Objectives. This prospective trial was performed to evaluate the impact of the morphologic complications of angioplasty on the reliability and results of quantitative angiographic assessment of the residual stenosis.Background. Postintervention quantitative coronary analysis is limited by a variety of such complications.Methods. In 199 patients undergoing an early control angiographic study within 24 h after coronary balloon or excimer laser angioplasty (24-h study), detailed quantitative angiographic measurements were performed on the target lesion immediately after intervention and at the 24-h study. Reproducibility of quantitative arteriography was determined by repeat measurements on the same angiogram.Results. Intraobserver/interobserver variability was significantly higher (p < 0.0001/p < 0.03) for the postintervention angiogram than for the 24-h angiogram. Patients were classified into three subgroups with respect to the occurrence of angiographic complications or chest pain after intervention. In patients with angiographic complications after balloon angioplasty alone/ stand-alone laser angioplasty/laser angioplasty with adjunctive balloon dilation, a significant difference in mean minimal lumen diameter (p = 0.0001/p = 0.03/p = 0.035) was observed between the immediate postintervention and 24-h angiogram. In patients without angiographic complications or patients with recurrent chest pain undergoing balloon angioplasty, stand-alone or adjunctive laser angioplasty, mean minimal lumen diameter remained nearly unchanged (p = NS).Conclusions. Angiographic measurements of the target lesion immediately after angioplasty were significantly less reliable than measurements obtained at 24 h after angioplasty in patients with angiographic complications. The occurrence of postintervention vascularcomplications was associated with significant early lesion changes between the immediate postangioplasty and the 24-h angiogram.