Strikwerda S, van Swijndregt E M, Melkert R, Serruys P W
Catheterization Laboratory, Thoraxcenter, University Hospital Dijkzigt, Erasmus University, Rotterdam, The Netherlands.
J Am Coll Cardiol. 1995 Feb;25(2):378-86. doi: 10.1016/0735-1097(94)00378-4.
Coronary lumen changes during and after excimer laser-assisted balloon angioplasty were measured by quantitative coronary angiography, and the results were compared with the effects of balloon angioplasty alone.
Reduction of atherosclerotic tissue mass by laser ablation in the treatment of coronary artery disease may be more effective in enlarging the lumen than balloon angioplasty alone.
A series of 57 consecutive coronary lesions successfully treated by xenon chloride excimer laser-assisted balloon angioplasty were individually matched with 57 coronary artery lesions successfully treated by balloon angioplasty alone. The following variables were measured by quantitative coronary analysis: 1) ablation by laser, 2) stretch by balloon dilation, 3) elastic recoil, and 4) acute gain.
Matching by stenosis location, reference diameter and minimal lumen diameter resulted in two comparable groups of 57 lesions with identical baseline stenosis characteristics. Minimal lumen diameter before excimer laser-assisted balloon angioplasty and balloon angioplasty alone were (mean +/- SD) 0.73 +/- 0.44 and 0.74 +/- 0.43 mm, respectively. Laser ablation significantly improved minimal lumen diameter by 0.56 +/- 0.44 mm before adjunctive balloon dilation. In both treatment groups, similar-sized balloon catheters (2.59 +/- 0.35 and 2.56 +/- 0.40 mm, respectively) were used. After laser-assisted balloon angioplasty, elastic recoil was 0.84 +/- 0.30 mm (32% of balloon size), which was identical to that after balloon angioplasty alone, namely, 0.82 +/- 0.32 mm (32%). Consequently, both interventions resulted in similar acute gains of 1.02 +/- 0.52 and 1.00 +/- 0.56 mm, respectively. Minimal lumen diameter after intervention was equal in both groups: 1.75 +/- 0.35 and 1.75 +/- 0.34 mm, respectively. The statistical power of this study in which a 25% difference in elastic recoil (0.2 mm) between groups was considered clinically important was 95%.
In matched groups of successfully treated coronary lesions, xenon chloride excimer laser ablation did not reduce immediate elastic recoil after adjunctive balloon dilation or improve the final angiographic outcome compared with balloon angioplasty alone using similar-sized balloon catheters.
通过定量冠状动脉造影测量准分子激光辅助球囊血管成形术期间及术后的冠状动脉管腔变化，并将结果与单纯球囊血管成形术的效果进行比较。
在冠状动脉疾病治疗中，通过激光消融减少动脉粥样硬化组织量可能比单纯球囊血管成形术在扩大管腔方面更有效。
将连续成功接受氯化氙准分子激光辅助球囊血管成形术治疗的57处冠状动脉病变，分别与连续成功接受单纯球囊血管成形术治疗的57处冠状动脉病变进行匹配。通过定量冠状动脉分析测量以下变量：1）激光消融；2）球囊扩张拉伸；3）弹性回缩；4）急性管腔增加量。
按狭窄部位、参考直径和最小管腔直径进行匹配，形成了两组各57处病变的可比组，两组具有相同的基线狭窄特征。准分子激光辅助球囊血管成形术和单纯球囊血管成形术术前的最小管腔直径分别为（均值±标准差）0.73±0.44和0.74±0.43mm。在辅助球囊扩张前，激光消融使最小管腔直径显著增加0.56±0.44mm。在两个治疗组中，使用了尺寸相似的球囊导管（分别为2.59±0.35和2.56±0.40mm）。激光辅助球囊血管成形术后，弹性回缩为0.84±0.30mm（球囊尺寸的32%），与单纯球囊血管成形术后相同，即0.82±0.32mm（32%）。因此，两种干预措施导致的急性管腔增加量相似，分别为1.02±0.52和1.00±0.56mm。两组干预后的最小管腔直径相等：分别为1.75±0.35和1.75±0.34mm。本研究中，若两组间弹性回缩有25%的差异（0.2mm）被认为具有临床意义，则其统计学检验效能为95%。
在成功治疗的冠状动脉病变匹配组中，与使用尺寸相似的球囊导管进行单纯球囊血管成形术相比，氯化氙准分子激光消融在辅助球囊扩张后并未降低即时弹性回缩，也未改善最终血管造影结果。
