Cook S L, Eigler N L, Shefer A, Goldenberg T, Forrester J S, Litvack F
Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA 90048.
Circulation. 1991 Aug;84(2):632-43. doi: 10.1161/01.cir.84.2.632.
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.
准分子激光冠状动脉成形术是一种用于治疗冠状动脉狭窄的新的研究性技术。初步报告已证实该手术的急性疗效和相对安全性，但尚未涉及病变类型对急性成功率和并发症发生率的影响。
在我们机构接受经皮准分子激光冠状动脉成形术的首批100例患者中，激光急性成功率为84%，手术成功率为94%。激光血管成形术中发生6例急性闭塞和1例心肌梗死。2例患者需要急诊冠状动脉搭桥手术。65%的患者因病变形态（管状、弥漫性或慢性完全闭塞）或开口位置而存在不适合球囊血管成形术的病变。有10例管状狭窄、29例弥漫性病变、18例慢性完全闭塞和8例开口病变，包括5例主动脉开口病变。在这个非理想亚组中，激光急性成功率为86%（慢性完全闭塞病变的成功率为72%，非完全闭塞病变的成功率为91%），手术成功率为94%。激光血管成形术中发生3例急性闭塞，但无心肌梗死、急诊搭桥手术或死亡。发生1例冠状动脉穿孔，无临床后遗症。在球囊血管成形术失败的6个病变中有4个（67%）激光血管成形术成功。在11个中度或重度钙化狭窄病变中有10个（91%）激光治疗成功。8个偏心病变和2个弯曲处病变成功治疗，无夹层或穿孔。在15例病变内有一个或多个主要分支起源的患者中，未发生侧支闭塞。47%的病例进行了辅助球囊血管成形术，通常是为了获得更大的最终管腔直径。在更大（2.0毫米）的激光导管可用后，辅助球囊血管成形术的需求降至36%。所治疗的105个病变中，28%为美国心脏病学会/美国心脏协会分类的A型，4%为B型，25%为C型。A型、B型和C型病变的激光成功率分别为83%、88%和85%，手术成功率分别为97%、96%和88%。
根据我们的初步经验，对于被认为不适合球囊血管成形术的病变，准分子激光血管成形术是一种急性有效且安全的治疗方法。该技术可能为选定患者提供球囊血管成形术的有用辅助手段或替代方法。
