Percutaneous excimer laser coronary angioplasty: results in the first consecutive 3,000 patients. The ELCA Investigators

Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California.

OBJECTIVES. We report the comprehensive results of the first consecutive 3,000 patients treated in an excimer laser coronary angioplasty registry. BACKGROUND. Excimer laser coronary angioplasty involves the use of a pulsed, 308-nm ultraviolet laser transmitted by optical fibers to reduce coronary stenoses. Preliminary reports have described safety and efficacy profiles in small numbers of patients. METHODS. Patients were enrolled in a prospective, nonrandomized manner. The catheters used were 1.3, 1.6, 2.0, 2.2 and 2.4 mm in diameter, at energy densities up to 70 mJ/mm2. Procedures were performed by standard angioplasty technique with conventional guide catheters. RESULTS. Seventy-five percent of patients were male, 68% were in Canadian Cardiovascular Society functional class III or IV and the cohort included 3,592 lesions. Procedural success (final stenosis < or = 50% without in-hospital Q wave myocardial infarction, coronary artery bypass surgery or death) was 90% and did not differ between the first 2,000 and the last 1,000 patients treated. There was no significant difference in success or complication rates with respect to lesion length, nor were there differences between selected complex and simple lesions. Complications included in-hospital bypass surgery (3.8%), Q wave myocardial infarction (2.1%) and death (0.5%). Coronary artery perforation occurred in 1.2% of patients (1% of lesions) but significantly decreased to 0.4% in the last 1,000 patients (0.3% of lesions). Angiographic dissection occurred in 13% of lesions, transient occlusion in 3.4% and sustained occlusion in 3.1%. Comprehensive lesion morphologic data collected in the latter portion of the study showed the procedure predominantly limited to American College of Cardiology-American Heart Association type B2 and C lesions, with no significant difference in short-term outcome between groups. CONCLUSIONS. Excimer laser angioplasty can be safely and effectively applied, even in a variety of complex lesions not well suited for percutaneous transluminal coronary angioplasty. These types may include aorto-ostial, long lesions, total occlusions crossable with a wire, diffuse disease and vein grafts. Most recent data show a trend for the selection of predominantly complex lesions and a reduction in the incidence of perforation. This procedure may broaden the therapeutic window for the interventional treatment of selected complex coronary artery disease.

This article has been cited by other articles:

				D. R. Holmes Jr and D. O. Williams Catheter-Based Treatment of Coronary Artery Disease: Past, Present, and Future Circ Cardiovasc Interv, August 1, 2008; 1(1): 60 - 73. [Abstract] [Full Text] [PDF]

				C. Klonaris, A. Katsargyris, A. Giannopoulos, and E. Bastounis Advances in Endovascular Treatment of Femoropopliteal Arterial Occlusive Disease Perspectives in Vascular Surgery and Endovascular Therapy, December 1, 2006; 18(4): 329 - 341. [Abstract] [PDF]

				R. Koster, C. W. Hamm, R. Seabra-Gomes, G. Herrmann, H. Sievert, C. Macaya, E. Fleck, K. Fischer, J. J. R. M. Bonnier, J. Fajadet, et al. Laser angioplasty of restenosed coronary stents: results of a multicenter surveillance trial J. Am. Coll. Cardiol., July 1, 1999; 34(1): 25 - 32. [Abstract] [Full Text] [PDF]

				R. Kornowski, R. Mehran, M. K. Hong, L. F. Satler, A. D. Pichard, K. M. Kent, G. S. Mintz, R. Waksman, J. R. Laird, A. J. Lansky, et al. Procedural Results and Late Clinical Outcomes After Placement of Three or More Stents in Single Coronary Lesions Circulation, April 14, 1998; 97(14): 1355 - 1361. [Abstract] [Full Text] [PDF]

				Y. E A Appelman, J. J Piek, W. K Redekop, P. J de Feyter, J. J Koolen, G. K David, S. Strikwerda, J. G P Tijssen, P. W Serruys, E v Swijndregt, et al. Clinical events following excimer laser angioplasty or balloon angioplasty for complex coronary lesions: subanalysis of a randomised trial Heart, January 1, 1998; 79(1): 34 - 38. [Abstract] [Full Text] [PDF]

				S. J. Brener, F. D. Loop, B. W. Lytle, S. G. Ellis, D. M. Cosgrove, and E. J. Topol A PROFILE OF CANDIDATES FOR REPEAT MYOCARDIAL REVASCULARIZATION: IMPLICATIONS FOR SELECTION OF TREATMENT J. Thorac. Cardiovasc. Surg., August 1, 1997; 114(2): 153 - 161. [Abstract] [Full Text]

				N. Reifart, M. Vandormael, M. Krajcar, S. Gohring, W. Preusler, F. Schwarz, H. Storger, M. Hofmann, J. Klopper, S. Muller, et al. Randomized Comparison of Angioplasty of Complex Coronary Lesions at a Single Center : Excimer Laser, Rotational Atherectomy, and Balloon Angioplasty Comparison (ERBAC) Study Circulation, July 1, 1997; 96(1): 91 - 98. [Abstract] [Full Text]

				S. B. King III Angioplasty From Bench to Bedside to Bench Circulation, May 1, 1996; 93(9): 1621 - 1629. [Full Text]

				S. G. Ellis, D. P. Miller, K. J. Brown, N. Omoigui, G. L. Howell, M. Kutner, and E. J. Topol In-Hospital Cost of Percutaneous Coronary Revascularization : Critical Determinants and Implications Circulation, August 15, 1995; 92(4): 741 - 747. [Abstract] [Full Text]

				B. H. Strauss, M. K. Natarajan, W. B. Batchelor, D. E. Yardley, J. A. Bittl, T. A. Sanborn, J. A. Power, L. E. Watson, R. Moothart, J. E. Tcheng, et al. Early and Late Quantitative Angiographic Results of Vein Graft Lesions Treated by Excimer Laser With Adjunctive Balloon Angioplasty Circulation, August 1, 1995; 92(3): 348 - 356. [Abstract] [Full Text]