Percutaneous Excimer Laser Coronary Angioplasty Research Articles

Effectiveness of excimer laser coronary angioplasty in acute myocardial infarction or in unstable angina pectoris

This study was conducted to evaluate the feasibility, safety, and acute results of percutaneous excimer laser coronary angioplasty (ELCA) in acute coronary syndromes. Fifty-nine patients were treated with ELCA (308 nm), including 33 patients with unstable angina pectoris (UAP) (35 vessels with 39 lesions) and 26 patients with acute myocardial infarction (AMI) (26 vessels with 29 lesions). In each patient the target lesion had a complex morphology. Overall, 71% of the patients had contraindications for pharmacologic thrombolytic agents or glycoprotein IIb/IIIa receptor antagonists. All patients received adjunct balloon dilation followed by stent implantation in 88% of patients with AMI versus 76% of patients with UAP (p = NS). Quantitative angiography was performed at an independent core laboratory; 86% laser success and 100% procedural success was achieved in the AMI group versus 87% laser success and 97% procedural success in the UAP group (p = NS). In the AMI group, the minimal luminal diameter increased from 0.77 ± 0.56 to 1.44 ± 0.47 mm after lasing to a final 2.65 ± 0.47 mm versus 0.77 ± 0.38 to 1.35 ± 0.4 mm after lasing to 2.66 ± 0.5 mm final in the UAP group. A prelaser percent stenosis of 76 ± 17% for the AMI group versus 70 ± 16% for the UAP group (p = NS) was decreased after lasing to 52 ± 16% for the AMI group versus 51 ± 14% for the UAP group (p = NS) and to a final stenosis of 15 ± 17% for the AMI group versus 12 ± 15% for the UAP group (p = NS). A 96% laser-induced reduction of thrombus burden area was achieved in the AMI group versus 97% in the UAP group (p = NS). Preprocedure Thrombolysis In Myocardial Infarction flow of 1.3 ± 0.9 in the AMI group versus 2.3 ± 1.2 for the UAP group (p = 0.01) increased to a final flow of 3.0 ± 0 for the AMI group versus 3.0 ± 0 for the UAP group (p = NS). There were no deaths, cerebrovascular accident, emergency bypass surgery, acute closure, major perforation or major dissection, distal embolization, or bleeding complications in either group. One patient with AMI had localized perforation (caused by guidewire) without sequelae and 1 patient with UAP had an abnormal increase in creatine kinase levels. All 59 patients survived the laser procedure, improved clinically, and were discharged. Thus, early experience in patients with acute coronary syndromes suggest that percutaneous ELCA is feasible and safe.

Predictors of outcome of percutaneous excimer laser coronary angioplasty of saphenous vein bypass graft lesions

A total of 495 patients underwent treatment with excimer laser angioplasty for 545 saphenous vein graft stenoses. Clinical success was achieved in 455 of 495 patients (92%), as indicated by ≤50% residual stenosis at every target lesion and no complication during hospitalization. At toast 1 in-hospital complication occurred in 30 of 495 patients (6.1%): death (1.0%), bypass surgery (0.6%), and Q-wave (2.4%) or non-Q-wave (2.2%) myocardial infarction. Relative risk analysis showed that ostial lesions (n = 65) tended to have higher clinical success (success rate = 95%, adjusted odds ratio [OR] = 2.1 [95% confidence interval (CI) 0.62, 6.88]; p = 0.24) and lower complications (complication rate = 0%, OR = 0.10 [CI 0.01, 0.79]; p = 0.03) than lesions in the body of the vein graft. Lesions >10 mm (n = 131) had lower success (success rate = 84%, OR = 0.30 [CI 0.16, 0.56]; p = 0.001) and higher complications (complication rate = 12%, OR = 3.3 [CI 1.6, 6.6]; p = 0.004) than discrete lesions. Lesions in small vein grafts <3.0 mm (n = 76) tended to have increased success (success rate = 94%, OR = 1.55 [CI 0.70, 3.44]; p = 0.39) and tower complications (complication rate = 2.2%, OR = 0.31 [CI 0.10, 0.94]; p = 0.03). Thus, excimer laser-facilrtated angioplasty has the most favorable outcome for discrete lesions located at the ostium of all grafts and in the body of smaller saphenous vein grafts. Comparison of excimer laser angioplasty with other treatments for these types of saphenous vein graft lesions is required to establish the clinical usefulness of excimer laser treatment.

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)

Acute complications of excimer laser coronary angioplasty: A detailed analysis of multicenter results

Objectives. The aim of this study was to document and analyze the incidence and consequences of complications of excimer laser coronary angioplasty.Background. Excimer laser coronary angioplasty has been reported to be a safe and feasible alternative or adjunct to conventional balloon angioplasty, but serious and unique complications have been observed.Methods. Data on 1,595 interventions of excimer laser coronary angioplasty in 1,521 patients were analyzed, using a merged data base fron the U.S. and European Percutaneous Excimer Laser Coronary Angioplasty (PELCA) registries.Results. Procedural success was achieved in 89.3% of interventions. Stand-alone laser angioplasty was performed in 17.8% of interventions. Complications included dissection (22.0%), vasospasm (6.1%), filling defects (4.8%), abrupt reclosure (6.1%), embolization (2.3%), perforation (2.4%), arrhythmia (0.7%) and aneurysm formation (0.3%). Major complications were non-Q wave myocardial infarction (2.3%), Q wave myocardial infarction (1.0%), coronary artery bypass grafting (3.1%) and death (0.7%). Logistic regression analysis revealed correlation between dissections and the use of larger catheter size (p = 0.0005), high energy per pulse levels (p = 0.0001 for native vessels), lesion length > 10 mm (p = 0.001) and presence of a side branch (p = 0.01). The incidence of perforations was higher in women (p = 0.004), in treatment of total occlusions (p = 0.02) and in the presence of a side branch (p = 0.03). Fatal complications were correlated with patients with multivessel disease (p < 0.0001), patients with acute myocardial infarction (p = 0.0069) and older patients (> 70 years old, p = 0.004). The incidence of major complications decreased after performance of 50 laser angioplasty procedures at one institution (p = 0.02).Conclusions. This analysis defines both the learning curve and the profile of complications for excimer laser angioplasty and provides insight into the selection of appropriate patients and proper performance of the procedure.

Percutaneous excimer laser coronary angioplasty: Results in the first consecutive 3,000 patients

Objectives. We report the comprehensive results of the first consecutive 3,000 patients treated in an excimer laser coronary angioplasty registry.Background. Excimer laser coronary angioplasty involves the use of a pulsed, 308-nm ultraviolet laser transmitted by optical fibers to reduce coronary stenoses. Preliminary reports have described safety and efficacy profiles in small numbers of patients. Methods. Patients were enrolled in a prospective, nonrandomized manner. The catheters used were 1.3, 1.6, 2.0, 2.2 and 2.4 mm in diameter, at energy densities up to 70 mJ/mm2. Procedures were performed by standard angioplasty technique with conventional guide catheters.Results. Seventy-five percent of patients were male, 68% were in Canadian Cardiovascular Society functional class III or IV and the cohort included 3,592 lesions. Procedural success (final stenosis ≤50% without in-hospital Q wave myocardial infarction, coronary artery bypass surgery or death) was 90% and did not differ between the first 2,000 and the last 1,000 patients treated. There was no significant difference in success or complication rates with respect to lesion length, nor were there differences between selected complex and simple lesions. Complications included in-hospital bypass surgery (3.8%), Q wave myocardial infarction (2.1%) and death (0.5%). Coronary artery perforation occurred in 1.2% of patients (1% of lesions) but significantly decreased to 0.4% in the last 1,000 patients (0.3% of lesions). Angiographic dissection occurred in 13% of lesions, transient occlusion in 3.4% and sustained occlusion in 3.1%. Comprehensive lesion morphologic data collected in the latter portion of the study showed the procedure predominantly limited to American College of Cardiology-American Heart Association type B2 and C lesions, with no significant difference in short-term outcome between groups.Conclusions. Excimer laser angioplasty can be safely and effectively applied, even in a variety of complex lesions not well suited for percutaneous transluminal coronary angioplasty. These types may include aorto-ostial, long lesions, total occlusions crossable with a wire, diffuse disease and vein grafts. Most recent data show a trend for the selection of predominantly complex lesions and a reduction in the incidence of perforation. This procedure may broaden the therapeutic window for the interventional treatment of selected complex coronary artery disease.

Morphological predictors of acute complications after percutaneous excimer laser coronary angioplasty. Results of a comprehensive angiographic analysis: importance of the eccentricity index.

Percutaneous excimer laser coronary angioplasty (ELCA) is a new technique for recanalization of arteries obstructed by coronary atherosclerosis. This study was conducted to assess the complication rate and determine the influence of clinical and angiographic characteristics on complications after ELCA. A detailed, quantitative, angiographic core laboratory analysis of patients undergoing ELCA was performed by two experienced angiographers who were not the primary laser angioplasty operators. Two hundred patients underwent 203 separate procedures on 220 lesions at three medical centers. Laser success was achieved in 180 lesions (81.8%) and procedural success in 199 (90.5%). Emergency coronary artery bypass graft (CABG) was required in five patients (2.5%). One patient suffered a Q wave myocardial infarction; there were no deaths. Also, acute closure and perforation occurred in 10 (4.5%) and three (1.4%) vessels, respectively. Coronary dissections after laser treatment were seen in 36 vessels (16.4%). Multivariate analysis found two independent preprocedural factors related to complications: eccentricity index, which is the percent deviation of the lesion lumen from the center of the artery (p = 0.0007), and proximal vessel diameter (p = 0.033). In addition, an abrupt proximal face of the lesion was associated with angiographic complications by univariate analysis (p = 0.051). Multivariate analysis showed the eccentricity index (p = 0.032) to be the only independent predictor for the occurrence of any one or more of the important complications (emergency CABG, perforation, acute closure, or Q wave myocardial infarction), whereas lesion angle greater than 45 degrees was a significant univariate predictor (p = 0.029). Other predictors of complications with balloon percutaneous transluminal coronary angioplasty, such as increased lesion length, rough edges, calcification, ulceration, and branch point, were not predictive of complications with the excimer laser. The degree of lesion eccentricity is the most powerful predictor of complications after ELCA. This and other morphological predictors may be of benefit in the selection of patients for ELCA as well as directing future development of this new technology.

Excimer laser coronary angioplasty: experience with a prototype multifibre catheter in patients with stable angina pectoris.

Percutaneous excimer laser coronary angioplasty (ELCA) was performed in a first group of 20 patients with stable angina pectoris caused by significant coronary stenosis, and long-term follow-up was evaluated. Prototype 4 to 5.5 French multifibre catheters with 18-20 quartz fibres of 100 microns diameter, concentrically arranged around a central lumen for taking up a guide wire, were coupled to a commercial XeCl excimer laser. Energy was delivered at a wavelength of 308 nm with a pulse duration of 60 or 120 ns. Operating at a repetition rate of 20 Hz, mean energy transmission was 13.4 +/- 6.8 mJ per pulse. In all but one patient the lesion could be passed by the catheter. Percent diameter stenosis decreased from 77.1 +/- 10.8% to 53.1 +/- 11.8% after ELCA. Complications were frequently observed, intracoronary thrombus formation in eight instances, dissection in six patients and spasm in five cases, causing total vessel occlusion in five procedures. All complications could be managed efficaciously by thrombolytic and vasodilating drugs and/or balloon angioplasty. Subsequent PTCA was performed in case of complication or insufficient stenosis reduction after ELCA in 18 patients with adequate results (residual stenosis, 28.5 +/- 10.2%). Long-term follow-up angiography, which could be performed in 16 of 19 laser treatments, demonstrated significant restenosis in only three patients. Our preliminary results suggest that, using ELCA, ablation of atherosclerotic lesions is feasible in most cases. However, compared with PTCA, stenosis reduction is significantly less, and the acute complication rate is much higher. Thus, further improvements of the catheter system are necessary in order to realize the advantages of excimer laser ablation, which can be demonstrated by experimental studies.

Percutaneous excimer laser coronary angioplasty of lesions not ideal for balloon angioplasty.

Excimer laser coronary angioplasty is a new, investigational technique for treating coronary artery stenoses. Initial reports have demonstrated acute efficacy and relative safety of this procedure, but have not addressed the effect of lesion type on acute success and complication rates. In the first 100 patients undergoing percutaneous excimer laser coronary angioplasty at our institution, acute laser success was obtained in 84% and procedural success was obtained in 94%. There were six acute closures during laser angioplasty and one myocardial infarction. Two patients required emergency coronary bypass surgery. Sixty-five percent of patients had lesions not ideal for balloon angioplasty because of lesion morphology (tubular, diffuse, or chronic total occlusion) or ostial location. There were 10 tubular stenoses, 29 diffuse lesions, 18 chronic total occlusions, and eight ostial lesions, including five aorto-ostial lesions. In this nonideal subgroup, the acute success rate with laser was 86% (72% of chronic total occlusions and 91% of non-totally occluded lesions), and the procedural success rate was 94%. There were three acute occlusions during laser angioplasty but no myocardial infarctions, emergency bypass surgeries, or deaths. One coronary artery perforation occurred without clinical sequelae. Laser angioplasty was successful in four of six lesions (67%) in which balloon angioplasty had failed. Laser success was obtained in 10 of 11 (91%) moderately or heavily calcified stenoses. Eight eccentric lesions and two lesions on bends were successfully treated without dissection or perforation. No side branch occlusions occurred in the 15 patients in whom one or more major branches originated within the lesion treated. Adjunctive balloon angioplasty was performed in 47% of cases, usually to obtain a larger final luminal diameter. Need for adjunctive balloon angioplasty decreased to 36% after a larger (2.0 mm) laser catheter became available. Twenty-eight percent of the 105 lesions treated were American College of Cardiology/American Heart Association classification type A, 47% were type B, and 25% were type C. Laser and procedural successes were obtained in 83% and 97% of type A, 88% and 96% of type B, and 85% and 88% of type C lesions, respectively. In our initial experience, excimer laser angioplasty was found to be acutely effective and safe therapy for lesions identified as not ideal for balloon angioplasty. This technique may provide a useful adjunct or alternative to balloon angioplasty in selected patients.

Percutaneous coronary excimer laser-assisted angioplasty: Initial multicenter experience in 141 patients

Initial multicenter clinical experience with percutaneous coronary excimer laser-assisted angioplasty is described for 158 lesions in 141 patients. Using a xenon chloride (308 nm) excimer laser generator and 1.5 to 1.75 mm catheters, excimer laser angioplasty was attempted at 135 ns pulse width, 25 to 40 Hz repetition rate, 2 to 5 s laser delivery time and 30 to 60 mJ/mm2+energy fluence. Laser success (> 20% improvement in luminal diameter) was achieved in 138 (87%) of 158 lesions, with a reduction to < 50% stenosis noted in 77 lesions (49%). Overall, laser-assisted balloon angioplasty success (< 50% residual stenosis without major complication) was observed in 129 (91%) of 141 patients. Procedural complications (abrupt closure 1.3%, side branch occlusion 1.9%, intimal dissection 6.3%, embolizalion 1.3%, filling defect 1.3%, perforation 1.9% and spasm 1.3% and major complications (non-Q wave myocardial infarction 4.8%, emergency coronary bypass surgery 3.5% and death 0%) were infrequent and predominantly related to subsequent balloon angioplasty. In the early follow-up period (range 1 to 10 months, mean 7), 111 (79%) of the 141 patients remain asymptomatic, whereas symptoms have recurred in 27 (19%) and 3 patients (2.1%) have died. Thus, percutaneous coronary excimer laser angioplasty appears to be a feasible and safe procedure. Assessment of the impact of this technology on the acute complications of and restenosis rates after angioplasty awaits further follow-up analysis.

Percutaneous coronary excimer laser angioplasty: Quantitative angiographic analysis demonstrates a correlation between post-laser residual stenosis and six month follow-up stenosis

Percutaneous coronary excimer laser angioplasty: Quantitative angiographic analysis demonstrates a correlation between post-laser residual stenosis and six month follow-up stenosis

Percutaneous coronary excimer laser-assisted balloon angioplasty: Initial clinical and quantitative angiographic results in 50 patients

The initial clinical experience and quantitative angiographic results of percutaneous coronary excimer laser-assisted balloon angioplasty are described for 55 lesions in 50 patients. With use of a xenon chloride (308 nm) excimer laser generator and 1.5 to 1.75 mm catheters, excimer laser angioplasty was attempted at 135 ns pulse width, 25 to 40 Hz repetition rate, 2 to 5 s laser delivery lime and 30 to 60 mj/mm2energy fluence. Laser success (>20% reduction in absolute percent diameter stenosis) was achieved in 41 (75%) of 55 lesions, with 100% subsequent balloon angioplasty success (<50% residual stenosis).By quantitative digital caliper technique, the percent diameter stenosis (mean ± SE) was reduced from 81 ± 1 % to 50 ± 3% after excimer laser angioplasty (p < 0.001) and to 20 ± 1% after balloon angioplasty (p < 0.001); minimal luminal diameter increased from 0.56 ± 0.04 to 1.46 ± 0.08 mm (p < 0.001) and 2.03 ± 0.07 mm (p < 0.001), respectively. By videodensitometric techniques, the percent area stenosis decreased from 86 ± 2% to 54 ± 3% after excimer angioplasty (p < 0.001) and to 26 ± 3% after balloon angioplasty (p < 0.001).There were no perforations, need for emergency bypass surgery or deaths. The overall incidence of abrupt closure (3.6%), dissection (1.8%), embolization (1.8%), filling defect (6%), myecardial infarction (5.5%), side branch occlusion (3.6%) or spasm (3.6%) was infrequent and more related to subsequent balloon angioplasty than to the laser procedure. In the early follow-up period (range 1 to 10 months, mean 7), 36 (72%) of the 50 patients remained asymptomatic; symptoms recurred in 14 patients (28%) in relation to abrupt closure in the first 24 h in 2 patients (3.6%), late closure in the first week in 2 patients (3.6%) and restenosis in 10 patients (20%).Thus, percutaneous coronary excimer laser angioplasty appears to be a feasible and safe procedure in selected patients. At present, the procedure is undergoing significant development, including modification of the delivery catheters and operating techniques. The impact of this technology on the angioplasty restenosis rate awaits further follow-up analysis.

Percutaneous excimer laser coronary angioplasty

To determine the efficacy of percutaneous excimer laser coronary angioplasty as an adjunct or alternative to conventional balloon angioplasty, 55 patients were studied in a multicenter trial. These patients underwent the procedure using a modification of conventional balloon angioplasty technique. A first-generation, 1.6-mm diameter catheter constructed of 12 individual silica fibers concentrically arranged around a guidewire lumen was used. Catheter tip energy density varied from 35 to 50 mJ/mm 2. The mean number of pulses delivered at 20 Hz was 1,272 ± 1,345. Acute success was defined as a ≥20% increase in stenotic diameter and a lumen of ≥ 1 mm in diameter after laser treatment. Acute success was achieved in 46 of 55 (84%) patients. Adjunctive balloon angioplasty was performed on 41 patients (75%). The percent diameter stenosis as determined by quantitative angiography decreased from a baseline of 83 ± 14 to 49 ± 11% after laser treatment and to 38 ± 12% in patients undergoing adjunctive balloon angioplasty. The mean minimal stenotic diameter increased from a baseline of 0.5 ± 0.4 to 1.6 ± 0.5 mm after laser treatment and to 2.1 ± 0.5 mm after balloon angioplasty. There were no deaths and no vascular perforations. One patient (1.8%) required emergency coronary bypass surgery. These data suggest that excimer laser energy delivered percutaneously by specially constructed catheters can safely ablate atheroma and reduce coronary stenoses.

Percutaneous coronary excimer laser angioplasty in patients with stable and unstable angina pectoris. Acute results and incidence of restenosis during 6-month follow-up.

A clinical study was conducted to evaluate the efficacy and safety of percutaneous coronary excimer laser angioplasty in 60 patients with coronary artery disease. Forty-nine patients had stable exertional angina, and 11 patients had unstable angina despite medical therapy. A novel 1.4-mm diameter catheter with 20 quartz fibers of 100-microns diameter each arranged concentrically around a central lumen suitable for a 0.014-in. flexible guide wire was coupled to an excimer laser. A commercial excimer laser emitting energy at a wavelength of 308 nm with a pulse duration of 60 nsec was used. The laser was operated at 20 Hz. Mean energy transmission was 30 +/- 5 mJ/mm2. In five of the 60 patients, laser angioplasty was not attempted. In 23 patients with laser ablation alone, percent stenosis decreased from 76 +/- 14% before to 27 +/- 17% after ablation and was 34 +/- 15% at the early follow-up angiogram. In 32 patients, additional balloon angioplasty was performed because of vessel closure after laser ablation in 11 and an insufficient qualitative result in 21 patients. Of the 11 patients with unstable angina, one patient died due to vessel closure 3 hours after intervention, and two patients developed a myocardial infarction. In 22 of 47 patients with late follow-up angiography, restenosis within the 6-month follow-up period occurred. Rate of restenosis was higher in patients treated with laser ablation and balloon angioplasty (16 of 28) than in patients treated with laser ablation alone (six of 19). These results suggest that coronary excimer laser angioplasty for ablation of obstructive lesions is feasible and safe in patients with stable angina. However, development of new catheter systems is necessary for an improved success rate.

Percutaneous coronary excimer laser angioplasty in patients with stable and unstable angina pectoris

Percutaneous coronary excimer laser angioplasty in patients with stable and unstable angina pectoris

Percutaneous excimer laser coronary angioplasty: Results of the first 110 procedures

Percutaneous excimer laser coronary angioplasty: Results of the first 110 procedures

Initial angiographic results in ablation of atherosclerotic plaque by percutaneous coronary excimer laser angioplasty without subsequent balloon dilatation

Percutaneous transluminal coronary excimer laser angioplasty was performed in 15 patients using a 1.3-mm diameter laser catheter. The catheter consists of 20 concentric quartz fibers of 100 μm diameter each located around a central lumen suitable for a 0.014-inch flexible guidewire. The catheter was coupled to an excimer laser delivering energy at a wavelength of 308 nm and at a pulsewidth of 60 ns. Quantitative analysis of the angiograms documented a decrease from 77 ± 15% diameter stenosis before intervention to 40 ± 22% after the first irradiation cycle and to 21 ± 17% after termination of laser ablation. The minimal lumen diameter increased from 0.4 ± 0.2 to 1.3 ± 0.4 and to 1.6 ± 0.4 mm, respectively. Vessel reocclusion was seen in 2 patients at 24-hour control angiography. No procedure-related major complication such as vessel perforation occurred. In 8 patients, however, intraluminal lucencies were seen, which were persistently visualized 24 hours after intervention in 6 patients. Despite pretreatment with intracoronary nitroglycerin, coronary spasm occurred in 8 patients and was reversible after additional sublingual vasodilator therapy. The results of this pilot study suggest that percutaneous coronary excimer laser angioplasty is feasible and effective for ablation of coronary lesions in selected patients and can be performed without subsequent conventional balloon angioplasty. The clinical impact of this new initerventional technique, however, remains to be assessed.

Primer on Laser Angioplasty

Focusing on the use of percutaneous excimer laser coronary angioplasty, this book provides a basic foundation in lasers and their application to cardiovascular disease for physicians who have little familiarity or limited experience with laser therapy. This second edition also gives information and suggests concepts to simulate solutions to unsolved clinical problems.

Percutaneous excimer laser angioplasty of aortocoronary saphenous vein grafts

Percutaneous coronary excimer laser angioplasty was successfully performed in two patients. An 85 year old woman with a 99% stenosis in a vein graft to a posterior descending artery had the stenosis reduced to 30% with laser angioplasty. Subsequent balloon angioplasty reduced the stenosis further to 20%. A second patient, a man aged 50 years, had multiple previous balloon angioplasties and stent implantation with two subsequent percutaneous atherectomies. Laser angioplasty of the vein graft to the obtuse marginal branch reduced the first of three sequential lesions from 60% to 40%, the second lesion from 90% to none and the third from 60% to 20% without the need for balloon angioplasty. Both procedures were well tolerated without chest pain, burning, vascular perforation or thrombus formation.These cases demonstrate the feasibility of safely performing percutaneous coronary excimer laser angioplasty. Additional studies are indicated to determine the clinical role and potential benefits of this procedure in relation to established procedures and other experimental devices.