Linnemeier T J, Rothbaum D A, Cumberland D C, Landin R J, Hodes Z I, Ball M W
Department of Cardiology, St. Vincent Hospital, Indianapolis, IN 46260.
J Invasive Cardiol. 1990 Jul-Aug;2(4):133-8.
Percutaneous laser-assisted thermal coronary angioplasty was attempted in 29 vessels (27 patients): 10 left anterior descending, 2 left circumflex and 17 mid-shaft (non-anastomotic) saphenous vein grafts. Argon or YAG laser thermal energy was applied via a 1.3, 1.6 or 1.9 mm metal capped probe followed by conventional balloon angioplasty in 27 vessels and sole thermal laser therapy in two vessels. The laser probe successfully crossed 83% (24/29) of vessels and subsequent balloon dilatation increased the success rate to 93% (25/27). Perforation occurred in a vein graft resulting in one in-hospital death post repeat emergency coronary artery bypass graft surgery. Angiographic follow-up was obtained in 85% (24/28) of vessels. Angiographic restenosis ( greater than 50% reduction in lumen diameter) occurred in 27% (3/11) of native coronary arteries and 62% (8/13) of saphenous vein grafts. Therefore, despite high initial success rates, the application of laser thermal energy with small laser probes relative to vessel size, followed by conventional balloon angioplasty, does not appear to alter restenosis. Further evaluation of coronary laser systems should be continued only with catheters that are capable of creating channels closer to the size of the vessel treated.
对29条血管（27例患者）尝试进行经皮激光辅助热冠状动脉成形术：10条左前降支血管、2条左旋支血管和17条中段（非吻合口）大隐静脉移植血管。通过1.3、1.6或1.9毫米金属头探头施加氩激光或钇铝石榴石激光热能，随后对27条血管进行传统球囊血管成形术，对2条血管仅进行热激光治疗。激光探头成功穿过了83%（24/29）的血管，随后的球囊扩张使成功率提高到93%（25/27）。一条静脉移植血管发生穿孔，导致患者在重复急诊冠状动脉旁路移植手术后院内死亡。85%（24/28）的血管进行了血管造影随访。造影剂显示再狭窄（管腔直径缩小大于50%）在27%（3/11）的自身冠状动脉和62%（8/13）的大隐静脉移植血管中出现。因此，尽管初始成功率较高，但相对于血管大小使用小型激光探头施加激光热能，随后进行传统球囊血管成形术，似乎并未改变再狭窄情况。仅应继续使用能够制造更接近所治疗血管大小通道的导管对冠状动脉激光系统进行进一步评估。
