Sanborn T A, Bittl J A, Hershman R A, Siegel R M
Department of Medicine, Mount Sinai Medical Center, New York, New York 10029.
J Am Coll Cardiol. 1991 May;17(6 Suppl B):169B-173B. doi: 10.1016/0735-1097(91)90954-8.
Initial multicenter clinical experience with percutaneous coronary excimer laser-assisted angioplasty is described for 158 lesions in 141 patients. Using a xenon chloride (308 nm) excimer laser generator and 1.5 to 1.75 mm catheters, excimer laser angioplasty was attempted at 135 ns pulse width, 25 to 40 Hz repetition rate, 2 to 5 s laser delivery time and 30 to 60 mJ/mm2 energy fluence. Laser success (greater than 20% improvement in luminal diameter) was achieved in 138 (87%) of 158 lesions, with a reduction to less than 50% stenosis noted in 77 lesions (49%). Overall, laser-assisted balloon angioplasty success (less than 50% residual stenosis without major complication) was observed in 129 (91%) of 141 patients. Procedural complications (abrupt closure 1.3%, side branch occlusion 1.9%, intimal dissection 6.3%, embolization 1.3%, filling defect 1.3%, perforation 1.9% and spasm 1.3% and major complications (non-Q wave myocardial infarction 4.8%, emergency coronary bypass surgery 3.5% and death 0%) were infrequent and predominantly related to subsequent balloon angioplasty. In the early follow-up period (range 1 to 10 months, mean 7), 111 (79%) of the 141 patients remain asymptomatic, whereas symptoms have recurred in 27 (19%) and 3 patients (2.1%) have died. Thus, percutaneous coronary excimer laser angioplasty appears to be a feasible and safe procedure. Assessment of the impact of this technology on the acute complications of and restenosis rates after angioplasty awaits further follow-up analysis.
本文描述了141例患者158处病变的经皮冠状动脉准分子激光辅助血管成形术的初步多中心临床经验。使用氯化氙（308纳米）准分子激光发生器和1.5至1.75毫米导管，以135纳秒的脉冲宽度、25至40赫兹的重复频率、2至5秒的激光发射时间和30至60毫焦/平方毫米的能量通量尝试进行准分子激光血管成形术。158处病变中有138处（87%）实现了激光成功（管腔直径改善超过20%），77处病变（49%）的狭窄程度降至50%以下。总体而言，141例患者中有129例（91%）观察到激光辅助球囊血管成形术成功（残余狭窄小于50%且无重大并发症）。手术并发症（急性闭塞1.3%、分支闭塞1.9%、内膜夹层6.3%、栓塞1.3%、充盈缺损1.3%、穿孔1.9%和痉挛1.3%）和重大并发症（非Q波心肌梗死4.8%、急诊冠状动脉搭桥手术3.5%和死亡0%）并不常见，且主要与随后的球囊血管成形术有关。在早期随访期（范围1至10个月，平均7个月），141例患者中有111例（79%）无症状，而27例（19%）症状复发，3例患者（2.1%）死亡。因此，经皮冠状动脉准分子激光血管成形术似乎是一种可行且安全的手术。该技术对血管成形术后急性并发症和再狭窄率的影响有待进一步的随访分析。
