Percutaneous laser-assisted thermal coronary angioplasty in native coronary arteries and saphenous vein grafts:  initial results and angiographic follow-up.
Percutaneous laser-assisted thermal coronary angioplasty was attempted in 29 vessels (27 patients):  10 left anterior descending, 2 left circumflex and 17 mid-shaft (non-anastomotic) saphenous vein grafts.  Argon or YAG laser thermal energy was applied via a 1.3, 1.6 or 1.9 mm metal capped probe followed by conventional balloon angioplasty in 27 vessels and sole thermal laser therapy in two vessels.  The laser probe successfully crossed 83% (24/29) of vessels and subsequent balloon dilatation increased the success rate to 93% (25/27).  Perforation occurred in a vein graft resulting in one in-hospital death post repeat emergency coronary artery bypass graft surgery.  Angiographic follow-up was obtained in 85% (24/28) of vessels.  Angiographic restenosis ( greater than 50% reduction in lumen diameter) occurred in 27% (3/11) of native coronary arteries and 62% (8/13) of saphenous vein grafts.  Therefore, despite high initial success rates, the application of laser thermal energy with small laser probes relative to vessel size, followed by conventional balloon angioplasty, does not appear to alter restenosis.  Further evaluation of coronary laser systems should be continued only with catheters that are capable of creating channels closer to the size of the vessel treated.
Department of Cardiology, St. Vincent Hospital, Indianapolis, IN 46260.
T J
TJ
Linnemeier
D A
DA
Rothbaum
D C
DC
Cumberland
R J
RJ
Landin
Z I
ZI
Hodes
M W
MW
Ball
D000328:Adult; D000368:Aged; D016342:Angioplasty, Laser / Q000009:adverse effects / Q000295:instrumentation*; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000601:surgery*; D003331:Coronary Vessels / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006083:Graft Occlusion, Vascular; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012501:Saphenous Vein / Q000000981:diagnostic imaging / Q000637:transplantation*