Eximer laser coronary angioplasty: Initial results of a multicenter investigation in 958 patients

Coronary rotational ablation for unsuccessful angioplasty due to failure to cross the stenosis with a dilatation catheter

Attempted coronary angioplasty of a right coronary artery sub-total occlusion was unsuccessful due to failure to cross the lesion with the dilatation catheter. Both fixed-wire and over-the-wire systems were tried. Coronary rotational ablation was successful in reducing the stenosis and allowing successful angioplasty.

Excimer laser coronary angioplasty

Recent experience with excimer laser coronary angioplasty (ELCA) has shown the safety and efficacy of the technique in the treatment of coronary stenosis, with results similar to percutaneous transluminal coronary angioplasty (PTCA). Several advantages of the excimer laser for intravascular use have been identified by the ELCA Registry, a group of 15 institutions nationally that have pooled data on their cooperative experience with ELCA. Advantages include the ability of the laser to ablate atheroma with microscopic precision without thermal injury and the ability of vessel surfaces to heal without scarring. The initial results of the multicenter investigation of ELCA in 958 patients indicate that ELCA may be indicated particularly for long, diffuse lesions. With the advent of larger diameter catheters, ELCA is a viable alternative to PTCA. Restenosis was seen as a significant problem, and it remained problematic at 6-month follow-up. In comparison with conventional balloon angioplasty, ELCA may eliminate that component of restenosis due to inadequate dilation or elastic recoil, but it does not appear to affect restenosis caused by smooth muscle proliferation. Catheter design and energy delivery continue to evolve and may affect future results of laser coronary angioplasty.

Excimer laser coronary angioplasty: results in restenosis versus de novo coronary lesions. Excimer Laser Coronary Angioplasty Investigators

There is limited information regarding the use of excimer laser coronary angioplasty (ELCA) in patients with restenotic lesions. The purpose of this investigation was to compare the results of ELCA in patients with restenosis following prior PTCA with results obtained in de novo (no restenosis) patients. A retrospective review was obtained of all patients undergoing attempted ELCA at each of the 12 participating clinical investigative centers. There were 620 patients in the prior restenosis group and 949 in the de novo group. Both laser success (88% vs 78%) and procedural success (92% vs 88%) were higher in restenosis lesions compared with de novo lesions (P less than 0.001). Six-month follow-up was available in 40% of patients. Restenosis occurred in 49% of the prior restenosis group vs 44% of the de novo group (P nonsignificant) but death was more common in the de novo group (2.2 vs 0.4%, P = 0.01). ELCA can be performed with a high success rate in patients with restenosis following prior balloon angioplasty but recurrent restenosis following laser procedure remains a significant problem.

Novel coronary interventional devices: an update

Interventional cardiologists today are overwhelmed by a hugh array of new high technology investigatory devices at their disposal for the treatment of coronary arterial obstructive disease. These include the various atherectomy and laser devices, developed and introduced into clinical practice with the promise and intent of solving the limitations of conventional balloon angioplasty, namely those of acute closure and restenosis. But as more experience and data are obtained from the application of these devices, it is becoming clear that the latter have generally not been able to accomplish what they were intended to do. Although the immediate success rates have been uniformly high, acute closure has persisted and restenosis remains unabated. Nevertheless, some of these new devices have shown some fairly encouraging results in specific clinical circumstances. The targeted use of these instruments may prove to be a step in the right direction. This article reviews the current state of the art and the potential utility of certain of these devices.