title: Recanalization of chronic total coronary occlusions using a laser guide wire: a pilot study.
abstract: OBJECTIVE
  This study sought to prospectively evaluate the performance of a laser guide wire in crossing chronic total coronary occlusions in patients with a failed previous mechanical guide wire attempt.
  
  
  BACKGROUND
  Despite continued refinement of mechanical hardware available for coronary angioplasty, restoration and maintenance of blood flow through a chronically occluded coronary artery remains a true challenge.
  
  
  METHODS
  Fifty patients with a chronic total coronary occlusion and a previous failed attempt at recanalization using mechanical guide wires were included. A mechanical attempt to cross the occlusion was repeated. In case of failure, an additional attempt was made with the laser guide wire.
  
  
  RESULTS
  The median age of occlusion was 22 weeks (range 5 to 200), and the occlusion length was 23 +/- 11 mm (mean +/- SD). A repeat mechanical attempt was successful in six cases (12%). Dissection occurred in five other cases, and device crossover was not attempted. Thus, in 39 patients an attempt was made with the laser guide wire, with successful recanalization in 23 (59%). Thereby the overall success rate increased from 12% to 58% (29 of 50 patients). The amount of contrast medium used was 515 +/- 154 ml, fluoroscopy time was 99 +/- 43 min, and total procedure time was 2 h 48 min (+/- 55 min). Procedural success was achieved in 26 cases and clinical success (procedural success without in hospital events) in 24. In-hospital events were two non-Q wave myocardial infarctions related to subacute reocclusion. In one patient, a balloon dilation after laser guide wire perforation resulted in tamponade requiring pericardiocentesis. After a successful procedure, the angina class decreased from 2.9 +/- 0.2 to 1.4 +/- 0.7 at 3 months of clinical follow-up. Six month angiographic follow-up was completed in all 24 eligible patients and showed vessel patency in 20 (80%).
  
  
  CONCLUSIONS
  The use of the laser guide wire for recanalization of chronic total coronary occlusions refractory to treatment with mechanical guide wires is feasible and relatively safe and was successful in 59% of cases. This device must thus be considered a valuable addition to the interventional armamentarium and accordingly will be evaluated in a randomized clinical trial.
authors.affiliation: Thoraxcenter, University Hospital Rotterdam, The Netherlands. hamburge@card.azr.nl
authors.forename: J N
authors.initials: JN
authors.lastname: Hamburger
authors.forename: G H
authors.initials: GH
authors.lastname: Gijsbers
authors.forename: Y
authors.initials: Y
authors.lastname: Ozaki
authors.forename: P N
authors.initials: PN
authors.lastname: Ruygrok
authors.forename: P J
authors.initials: PJ
authors.lastname: de Feyter
authors.forename: P W
authors.initials: PW
authors.lastname: Serruys
mesh_terms: D015906:Angioplasty, Balloon, Coronary / Q000295:instrumentation*; D003327:Coronary Disease / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053685:Laser Therapy; D007834:Lasers / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011446:Prospective Studies; D015607:Stents