Ambrosini V, Cioppa A, Salemme L, Tesorio T, Sorropago G, Popusoi G, Stabile E, Medolla A, Cangella F, Agrusta M, Picano E, Rubino P
CNR, Institute of Clinical Physiology, Pisa, Italy; Clinica Cardiologica "Montevergine", Mercogliano, Italy.
Int J Cardiol. 2008 Jun 23;127(1):98-102. doi: 10.1016/j.ijcard.2007.10.060. Epub 2008 Feb 15.
Pulsed-wave ultraviolet excimer laser light at 308 nm can vaporise thrombus, suppress platelet aggregation, and, unlike other thrombectomy devices, ablates the underlying plaque.
To evaluate both safety and efficacy of laser ablation in patients presenting with Acute Myocardial Infarction (AMI) complicated by persistent thrombotic occlusion.
From May 2003 to October 2006, we enrolled 66 AMI patients (age 59+/-11 years; 57 men) presenting complete thrombotic occlusion of the infarct related vessel. All patients were treated with laser. Primary acute angiographic end-points was corrected TIMI frame count. Secondary echocardiographic end-point was left ventricular remodeling defined as an increase in end-diastolic volume >/=20% 6 months after infarction. Tertiary clinical endpoint was event-free survival at 6 months follow-up.
There were no intra-procedural death or coronary perforation. One primary angiographic failure was observed during lasing. Major dissection occurred in 1 (1.5%) and distal embolization in 4 patients (6%). Corrected TIMI frame count was 100 at baseline, 29+/-0.6 after lasing and 22+/-3 after stenting. At 6-months follow-up, left ventricular remodeling occurred in 8% patients. Event-free survival was 95% at 6-months follow-up.
Laser angioplasty is feasible, safe and effective for the challenging treatment of patients with AMI and thrombus-laden lesions. The acute effects on coronary epicardial and myocardial reperfusion are excellent.
308纳米的脉冲波紫外线准分子激光能够汽化血栓，抑制血小板聚集，并且与其他血栓切除术设备不同的是，它能够消融潜在的斑块。
评估激光消融术在患有急性心肌梗死（AMI）并伴有持续性血栓闭塞患者中的安全性和有效性。
从2003年5月至2006年10月，我们纳入了66例梗死相关血管完全血栓闭塞的AMI患者（年龄59±11岁；57例男性）。所有患者均接受激光治疗。主要的急性血管造影终点是校正的TIMI帧数。次要的超声心动图终点是左心室重构，定义为梗死后6个月舒张末期容积增加≥20%。第三级临床终点是6个月随访时的无事件生存率。
术中无死亡或冠状动脉穿孔发生。激光治疗期间观察到1例主要血管造影失败。1例（1.5%）发生严重夹层，4例（6%）发生远端栓塞。校正的TIMI帧数基线时为100，激光治疗后为29±0.6，支架置入后为22±3。在6个月随访时，8%的患者发生左心室重构。6个月随访时无事件生存率为95%。
激光血管成形术对于AMI和血栓负荷病变患者的挑战性治疗是可行、安全且有效的。对冠状动脉心外膜和心肌再灌注的急性效果极佳。
