Initial angiographic results in ablation of atherosclerotic plaque by percutaneous coronary excimer laser angioplasty without subsequent balloon dilatation

Percutaneous transluminal coronary excimer laser angioplasty was performed in 15 patients using a 1.3-mm diameter laser catheter. The catheter consists of 20 concentric quartz fibers of 100 microns diameter each located around a central lumen suitable for a 0.014-inch flexible guidewire. The catheter was coupled to an excimer laser delivering energy at a wavelength of 308 nm and at a pulsewidth of 60 ns. Quantitative analysis of the angiograms documented a decrease from 77 +/- 15% diameter stenosis before intervention to 40 +/- 22% after the first irradiation cycle and to 21 +/- 17% after termination of laser ablation. The minimal lumen diameter increased from 0.4 +/- 0.2 to 1.3 +/- 0.4 and to 1.6 +/- 0.4 mm, respectively. Vessel reocclusion was seen in 2 patients at 24-hour control angiography. No procedure-related major complications such as vessel perforation occurred. In 8 patients, however, intraluminal lucencies were seen, which were persistently visualized 24 hours after intervention in 6 patients. Despite pretreatment with intracoronary nitroglycerin, coronary spasm occurred in 8 patients and was reversible after additional sublingual vasodilator therapy. The results of this pilot study suggest that percutaneous coronary excimer laser angioplasty is feasible and effective for ablation of coronary lesions in selected patients and can be performed without subsequent conventional balloon angioplasty. The clinical impact of this new interventional technique, however, remains to be assessed.