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Treatment of in-stent coronary restenosis with excimer laser angioplasty
Authors:Meilin Liu  W.H.Chow  O.H.Kwok
Affiliation:Cardiac Medical Unit, Grantham Hospital, Hong Kong, China;Cardiac Medical Unit, Grantham Hospital, Hong Kong, China;Cardiac Medical Unit, Grantham Hospital, Hong Kong, China;Cardiac Medical Unit, Grantham Hospital, Hong Kong, China;Cardiac Medical Unit, Grantham Hospital, Hong Kong, China;Cardiac Medical Unit, Grantham Hospital, Hong Kong, China;Cardiac Medical Unit, Grantham Hospital, Hong Kong, China
Abstract:OBJECTIVE: To evaluate the efficacy and safety of excimer laser coronary angioplasty (ELCA) with adjunctive balloon angioplasty in patient with in-stent restenosis. METHODS: ELCA was performed in 20 patients of instent restenosis. All patients were symptomatic and had class III-IV angina. ELCA was performed with the Spectranetics CVX-300 System. The laser catheter of Vittesse C (concentric) and E (eccentric) with diameter of 1.4-2.0 mm was used. RESULTS: Laser catheter crossed all stenotic stents without difficulty. The lesion length was 4.6-51.2 mm, mean 20.7 +/- 13.7 mm, including 14 lesions > 10 mm. Laser treatment alone increased minimal lumen diameter (MLD) from 0.3 +/- 0.3 mm to 1.4 +/- 0.3 mm (P < 0.0001) and improved the diameter stenosis from 88.8% +/- 10.0% to 46.0% +/- 8.0% (P < 0.0001). Adjunctive balloon angioplasty further increased minimal lumen diameter to 2.3 +/- 0.7 mm and reduced diameter stenosis to 14.2% +/- 8.2% (P < 0.0001). At follow-up (1-17 months, mean 8.9 +/- 5.7 months), 17 (85%) patients had remained asymptomatic, 3 (15%) patients had mild to moderate exertional angina, 1 (5%) patient received CABG. CONCLUSION: ELCA with adjunctive percutaneous transluminal coronary angioplasty (PTCA) is an efficient and safe technique to debulk tissue in the patient with in-stent restenosis. The incidence of procedural related complication was low and ELCA may be used as a good method for in-stent restenosis treatment.
Keywords:excimer laser coronary angioplasty   in-stent restenosis    PTCA
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