Department of Cardiology, Tokyo Metropolitan Hiroo Hospital, 2-34-10, Ebisu, Shibuya-ku, Tokyo, 153-0013, Japan.
Department of Cardiovascular Medichine, Tokyo Medical and Dental Hospital, Tokyo, Japan.
Lasers Med Sci. 2019 Dec;34(9):1747-1754. doi: 10.1007/s10103-019-02772-x. Epub 2019 Mar 16.
Excimer laser coronary angioplasty (ELCA) is a unique revascularization modality that can vaporize plaque and thrombus. Compared to thrombus aspiration therapy, ELCA is reported to provide better microcirculation and reduced peripheral embolism in treatment for acute coronary syndrome. Excimer laser catheters come in various sizes, and we sought to compare the 0.9- and 1.4-mm-diameter catheters. We retrospectively enrolled 90 acute myocardial infarction (AMI) patients who underwent primary percutaneous coronary intervention with excimer laser from August 2013 to March 2017 in our hospital. Patients were grouped by diameter of catheter that had been used, the 0.9 mm group (n = 51) and 1.4 mm group (n = 39). We evaluated myocardial perfusion, procedural success rate, short-term outcome, lesion crossability, and complications between the two groups. The percentage of patients whose final thrombolysis in myocardial infarction (TIMI) grade was 3 (0.9 mm 86.3% vs 1.4 mm 89.7% p = 0.75) and final myocardial blush grade (MBG) was 3 (0.9 mm 72.5% vs 1.4 mm 69.2% p = 0.82) was similarly high for both groups. Procedural success rate, in-hospital major adverse cardiac events (MACE), lesion crossability, and complications were also similar. This study showed that efficacy of 0.9 and 1.4 mm excimer laser catheter was equivalent in ELCA for AMI patients. If one takes into account lesion crossability, debulking effects, and the stunned platelets phenomenon, the 0.9 mm excimer laser catheter is sufficient for ELCA in AMI patients.
准分子激光冠状动脉血管成形术（ELCA）是一种独特的血管重建方式，可汽化斑块和血栓。与血栓抽吸治疗相比，ELCA 可改善急性冠状动脉综合征患者的微循环，减少外周栓塞。准分子激光导管有多种尺寸，我们试图比较 0.9 毫米和 1.4 毫米直径的导管。我们回顾性地纳入了 2013 年 8 月至 2017 年 3 月期间在我院接受准分子激光治疗的 90 例急性心肌梗死（AMI）患者。患者根据所用导管的直径分组，0.9 毫米组（n=51）和 1.4 毫米组（n=39）。我们评估了两组患者的心肌灌注、手术成功率、短期结果、病变可通过性和并发症。最终 TIMI 血流分级为 3 级的患者比例（0.9 毫米组为 86.3%，1.4 毫米组为 89.7%，p=0.75）和最终心肌染色分级为 3 级的患者比例（0.9 毫米组为 72.5%，1.4 毫米组为 69.2%，p=0.82）相似。手术成功率、住院期间主要不良心脏事件（MACE）、病变可通过性和并发症也相似。本研究表明，0.9 毫米和 1.4 毫米准分子激光导管在 AMI 患者的 ELCA 中的疗效相当。如果考虑到病变可通过性、减容效果和顿抑血小板现象，0.9 毫米准分子激光导管对于 AMI 患者的 ELCA 已经足够。
