title: Six-month clinical and angiographic outcome after successful excimer laser angioplasty for in-stent restenosis.
abstract: OBJECTIVE
  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 > or = 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 > or =50% diameter stenosis was present in 48 patients (54%); in 24 of these patients diameter stenosis was > or =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.
authors.affiliation: University Hospital Eppendorf, Medical Clinic, Department of Cardiology, Hamburg, Germany.
authors.forename: R
authors.initials: R
authors.lastname: Köster
authors.forename: J
authors.initials: J
authors.lastname: Kähler
authors.forename: W
authors.initials: W
authors.lastname: Terres
authors.forename: J
authors.initials: J
authors.lastname: Reimers
authors.forename: S
authors.initials: S
authors.lastname: Baldus
authors.forename: D
authors.initials: D
authors.lastname: Hartig
authors.forename: J
authors.initials: J
authors.lastname: Berger
authors.forename: T
authors.initials: T
authors.lastname: Meinertz
authors.forename: C W
authors.initials: CW
authors.lastname: Hamm
mesh_terms: D000328:Adult; D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000379:methods*; D017222:Angioplasty, Balloon, Laser-Assisted; D017023:Coronary Angiography; D003327:Coronary Disease / Q000000981:diagnostic imaging / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012008:Recurrence; D012086:Reoperation; D015607:Stents; D016896:Treatment Outcome