Laser angioplasty of restenosed coronary stents: Results of a multicenter surveillance trial

Ralf Köster, Christian W. Hamm, Ricardo Seabra-Gomes, Gunhild Herrmann, Horst Sievert, Carlos Macaya, Eckart Fleck, Klaus Fischer, Johannes J R M Bonnier, Jean Fajadet, J. ürgen Waigand, Karl Heinz Kuck, Michel Henry, Marie Claude Morice, Luciano Pizzulli, Michael M. Webb-Peploe, Arnd B. Buchwald, Lars Ekström, Eberhard Grube, Saad Al KasabAntonio Colombo, Archimedes Sanati, Sjef M P G Ernst, Michael Haude, Martin B. Leon, Charles Ilsley, Rafael Beyar, Yvo Taeymans, Uwe Gladbach, Karl Wegscheider, Patrick W. Serruys

Research output: Contribution to journalArticle

Abstract

OBJECTIVES: This study evaluated safety and efficacy of excimer laser angioplasty for treatment of restenosed or occluded coronary stents. BACKGROUND: Balloon angioplasty of in-stent restenosis is limited by a high recurrence rate. Debulking by laser angioplasty is a novel concept to treat in-stent restenosis. METHODS: A total of 440 patients with restenoses or occlusions in 527 stents were enrolled for treatment with concentric or eccentric laser catheters and adjunctive balloon angioplasty. RESULTS: Laser angioplasty success (≤50% diameter stenosis after laser treatment or successful passage with a 2.0-mm or 1.7-mm eccentric laser catheter) was achieved in 92% of patients. Adjunctive balloon angioplasty was performed in 99%. Procedural success (laser angioplasty success followed by ≤30% stenosis with or without balloon angioplasty) was 91%. There was neither a significant difference in success with respect to lesion length, nor were there differences between small and large vessels or native vessels and vein grafts. Success was higher and residual stenosis lower using large or eccentric catheters. Serious adverse events included death (1.6%, not directly laser catheter related), Q-wave myocardial infarction (0.5%), non-Q- wave infarction (2.7%), cardiac tamponade (0.5%) and stent damage (0.5%) . Perforations after laser treatment occurred in 0.9% of patients and after balloon angioplasty in 0.2%. Dissections were visible in 4.8% of patients after laser treatment and in 9.3% after balloon angioplasty. Reinterventions during hospitalization were necessary in 0.9% of patients; bypass surgery was performed in 0.2%. CONCLUSIONS: Excimer laser angioplasty with adjunctive balloon angioplasty is a safe and efficient technology to treat in-stent restenoses. These data justify a randomized comparison with balloon angioplasty.

Original languageEnglish (US)
Pages (from-to)25-32
Number of pages8
JournalJournal of the American College of Cardiology
Volume34
Issue number1
DOIs
StatePublished - Jul 1999
Externally publishedYes

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ASJC Scopus subject areas

  • Nursing(all)

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Köster, R., Hamm, C. W., Seabra-Gomes, R., Herrmann, G., Sievert, H., Macaya, C., Fleck, E., Fischer, K., Bonnier, J. J. R. M., Fajadet, J., Waigand, J. Ü., Kuck, K. H., Henry, M., Morice, M. C., Pizzulli, L., Webb-Peploe, M. M., Buchwald, A. B., Ekström, L., Grube, E., ... Serruys, P. W. (1999). Laser angioplasty of restenosed coronary stents: Results of a multicenter surveillance trial. Journal of the American College of Cardiology, 34(1), 25-32. https://doi.org/10.1016/S0735-1097(99)00167-9