Margolis J R, Litvack F, Krauthamer D, Trautwein R, Goldenberg T, Grundfest W
Cardiovascular Laboratory, South Miami Hospital, FL.
Herz. 1990 Aug;15(4):223-32.
Second generation angioplasty devices remove rather than displace atherosclerotic plaque. For such devices to be useful they must be capable of addressing the major problems not solved by balloon catheters: difficult anatomy, abrupt reclosure, and restenosis. Laser angioplasty systems have proven difficult to adapt to treatment of coronary artery disease, because of heat generation, problems with perforation, and inflexibility of optical fibers. The AIS excimer laser coronary angioplasty system couples a 308 nm pulsed excimer laser to multifiber over-the-wire catheters of 1.3 mm, 1.6 mm, and 2.0 mm diameters. The laser's uniquely long pulse width (250 ns) allows delivery of higher energies through smaller fibers. Because the catheter system is front firing, risk of perforation is reduced. The Excimer Laser Coronary Angioplasty Registry involves six institutions investigating the AIS excimer system. This report deals with 255 lesions in the first 210 patients in the registry. The study cohort resembles a standard angioplasty population in terms of demographics, symptomatology, vessels dilated, and complications. Unlike a standard PTCA cohort, the ELCA patients had a higher prevalence of chronic total occlusions, calcified lesions, long lesions and diffuse disease. Both very distal lesions and those that had previously failed PTCA were successfully treated with ELCA. The laser was successful in 85% of cases, but adjunctive balloon angioplasty was required in the majority. There were no instances of perforation.
第二代血管成形术设备是去除而非移位动脉粥样硬化斑块。要使这类设备有用，它们必须能够解决球囊导管未解决的主要问题：解剖结构复杂、急性再闭塞和再狭窄。事实证明，激光血管成形术系统难以应用于冠状动脉疾病的治疗，因为会产生热量、存在穿孔问题以及光纤缺乏柔韧性。AIS准分子激光冠状动脉血管成形术系统将一台308纳米脉冲准分子激光与直径为1.3毫米、1.6毫米和2.0毫米的多纤维超滑导丝导管相结合。激光独特的长脉冲宽度（250纳秒）使得能够通过更细的光纤传输更高的能量。由于导管系统是前向发射的，穿孔风险降低。准分子激光冠状动脉血管成形术注册研究涉及六个机构，对AIS准分子系统进行调查。本报告涉及该注册研究中前210名患者的255处病变。在人口统计学、症状学、扩张血管及并发症方面，该研究队列与标准血管成形术人群相似。与标准经皮冠状动脉腔内血管成形术（PTCA）队列不同，准分子激光冠状动脉血管成形术（ELCA）患者慢性完全闭塞、钙化病变、长病变和弥漫性疾病的患病率更高。极远端病变以及先前PTCA治疗失败的病变均成功接受了ELCA治疗。激光治疗在85%的病例中取得成功，但大多数病例需要辅助球囊血管成形术。未发生穿孔情况。
