Laser angioplasty and laser-induced thrombolysis in revascularization of anomalous coronary arteries.
Acute coronary syndromes such as unstable angina and myocardial infarction are attributed to a pathophysiologic process that involves rupture of atherosclerotic plaque and subsequent thrombosis. Percutaneous intervention of anomalous coronary arteries in patients who present with acute coronary syndromes impose unique technical challenges related to the specific anatomic course and morphology of these vessels. Selection of appropriate guiding catheter configuration, choice of supportive guidewire, and proper delivery and activation of debulking devices and stents are important steps toward achieving adequate results. Excimer laser angioplasty is a debulking technology for removal of atherosclerotic plaque and associated thrombi. To date, application of laser angioplasty in anomalous coronary arteries is unreported. We herein present clinical data and discuss technical aspects related to performance of excimer laser angioplasty in three symptomatic patients with acute coronary syndrome, two having an anomalous right coronary artery and one with an anomalous circumflex artery. The delivery of laser energy in these cases resulted in rapid thrombolysis of an occlusive thrombus, successful debulking of the underlying atherosclerotic plaque, facilitation of adjunct balloon angioplasty and stenting, and ultimately, improved clinical condition.
Shah
Rakesh
R
Division of Cardiology, Medical College of Virginia/Virginia Commonwealth University, Richmond, VA 23249, USA.
Martin
Robert E
RE
Topaz
On
O
D000368:Aged; D017222:Angioplasty, Balloon, Laser-Assisted / Q000295:instrumentation / Q000592:standards*; D003324:Coronary Artery Disease / Q000150:complications / Q000601:surgery*; D003330:Coronary Vessel Anomalies / Q000150:complications / Q000601:surgery*; D006801:Humans; D053685:Laser Therapy; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology / Q000601:surgery*; D009204:Myocardial Revascularization / Q000295:instrumentation / Q000379:methods; D015607:Stents; D015912:Thrombolytic Therapy / Q000379:methods