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CLINICAL STUDIES: INTERVENTIONAL CARDIOLOGY

Six-month clinical and angiographic outcome after successful excimer laser angioplasty for in-stent restenosis

^a University Hospital Eppendorf, Medical Clinic, Department of Cardiology, Hamburg, Germany

Manuscript received October 26, 1999; revised manuscript received January 18, 2000, accepted March 24, 2000.

Reprint requests and correspondence: Prof. Dr. Thomas Meinertz, University Hospital Eppendorf, Medical Clinic, Dept. of Cardiology, Martinistraße 52, 20246 Hamburg, Germany.
meinertz{at}uke.uni-hamburg.de

OBJECTIVES

This study evaluated the clinical and angiographic six-month follow-up after excimer laser coronary angioplasty (ELCA) for restenosed coronary stents.

BACKGROUND

Excimer laser coronary angioplasty has recently been shown to be safe and efficient for the treatment of in-stent restenosis.

METHODS

Ninety-six consecutive patients successfully treated with ELCA within 141 stents were included in a six-month clinical and angiographic follow-up.

RESULTS

During follow-up there was one sudden death and one patient with documented myocardial infarction. Angina pectoris classified as Canadian Cardiovascular Society II reoccurred in 49 patients. Follow-up angiography was obtained in 89 patients (93%) with 133 stents. Quantitative coronary angiography revealed a mean diameter stenosis of 77 ± 10% before intervention, 41 ± 12% after laser treatment and 11% ± 12% after adjunctive percutaneous transluminal coronary angioplasty (p < 0.001). Six months after ELCA the mean diameter stenosis had increased to 60 ± 26% (p < 0.001). A 50% diameter stenosis was present in 48 patients (54%); in 24 of these patients diameter stenosis was 70%. Total occlusions occurred in an additional 10 patients (11%). There was a trend toward an increased recurrent restenosis rate in patients with diabetes mellitus and long lesions or total occlusions (p = 0.059). Forty-eight patients (50%) received medical treatment after six months. Reinterventions were necessary in 30 patients (31%), and coronary artery bypass surgery was performed in 17 patients (18%). Event-free survival was 50%.

CONCLUSIONS

Excimer laser angioplasty for in-stent restenosis was associated with a high incidence of recurrent restenosis in this group of patients, suggesting that this technique is unlikely to reduce recurrent in-stent restenosis and that other approaches are necessary.

Abbreviations and Acronyms   CCS = Canadian Cardiovascular Society   ELCA = excimer laser coronary angioplasty   MLD = minimal lumen diameter   PTCA = percutaneous transluminal coronary angioplasty   TIMI = Thrombolysis in Myocardial Infarction (trial)

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