Mintz G S, Kovach J A, Javier S P, Pichard A D, Kent K M, Popma J J, Salter L F, Leon M B
Intravascular Ultrasound Imaging Laboratory, Washington DC Hospital Center, Washington, DC 20010, USA.
Circulation. 1995 Dec 15;92(12):3408-14. doi: 10.1161/01.cir.92.12.3408.
The mechanisms of excimer laser coronary angioplasty (ELCA) have never been studied in human coronary arteries in vivo.
ELCA was used to treat 202 lesions in 190 patients. Forty-nine lesions in 48 patients were studied by use of sequential (before and after ELCA and after adjunctive device therapy) intravascular ultrasound (IVUS). External elastic membrane (EEM), lumen, and plaque+media (P+M = EEM-lumen) cross-sectional areas (CSAs) and lesion arcs of calcium were measured before and after ELCA and after adjunct device use. Lumen improvement after ELCA (1.4 +/- 0.5 to 2.7 +/- 0.8 mm2) was the result of both tissue ablation (decrease in P+M CSA from 16.8 +/- 7.1 to 15.9 +/- 6.7 mm2, P < .0001) and vessel expansion (increase in EEM CSA from 18.2 +/- 7.1 to 18.6 +/- 6.8 mm2, P = .0245), with no change in calcium. The decrease in P+M CSA was 39% of the CSA of the laser catheter used. Dissections were present in 39% of lesions, 84% within superficial calcium; fibrocalcific deposits developed a "fragmented" appearance.
ELCA increased lumen CSA by both atheroablation and vessel expansion without calcium ablation. Superficial fibrocalcific deposits developed a characteristic fragmented appearance. These findings support both photoablation and forced vessel expansion as mechanisms of lumen enlargement and plaque dissection after ELCA.
