Kochs M, Haerer W, Eggeling T, Hoeher M, Schmidt A, Hombach V
Department of Internal Medicine IV (Cardiology, Angiology, Pneumonology), University of Ulm, Germany.
Eur Heart J. 1992 Mar;13(3):338-47. doi: 10.1093/oxfordjournals.eurheartj.a060172.
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.
对第一组20例由严重冠状动脉狭窄引起的稳定型心绞痛患者进行了经皮准分子激光冠状动脉成形术（ELCA），并评估了长期随访情况。将4至5.5法国规格的多纤维导管原型与商用XeCl准分子激光相连，该导管有18至20根直径为100微米的石英纤维，围绕用于容纳导丝的中心腔同心排列。能量以308纳米的波长输送，脉冲持续时间为60或120纳秒。以20赫兹的重复频率运行，每个脉冲的平均能量传输为13.4±6.8毫焦。除1例患者外，所有患者的病变均可通过导管。经ELCA后，直径狭窄百分比从77.1±10.8%降至53.1±11.8%。经常观察到并发症，8例发生冠状动脉内血栓形成，6例出现夹层，5例出现痉挛，导致5例手术中血管完全闭塞。所有并发症均可通过溶栓和血管扩张药物和/或球囊血管成形术有效处理。18例患者在出现并发症或ELCA后狭窄减轻不足时进行了后续的经皮冠状动脉腔内血管成形术（PTCA），结果良好（残余狭窄，28.5±10.2%）。在19次激光治疗中的16次中可以进行长期随访血管造影，仅3例患者显示有明显再狭窄。我们的初步结果表明，使用ELCA，在大多数情况下消融动脉粥样硬化病变是可行的。然而，与PTCA相比，狭窄减轻明显较少，急性并发症发生率要高得多。因此，为了实现准分子激光消融的优势，导管系统需要进一步改进，这可以通过实验研究得到证明。
