title: A prospective multicenter registry of laser therapy for degenerated saphenous vein graft stenosis: the COronary graft Results following Atherectomy with Laser (CORAL) trial.
abstract: OBJECTIVE
  The primary aim of this study was to prospectively evaluate the safety and efficacy of Excimer laser atherectomy as a primary treatment strategy in consecutively eligible patients presenting for percutaneous coronary intervention (PCI) of degenerated saphenous vein graft (SVG) lesions using a multicenter registry. Prior single-center experience suggested that laser atherectomy may decrease acute procedural complications during treatment of degenerated SVGs, including lesions not amenable to distal protection devices (DPDs).
  
  
  METHODS
  The COronary graft Results following Atherectomy with Laser investigators enrolled 98 patients at 18 centers between June 23, 2003, and October 4, 2004, with greater than 50% stenosis of an SVG who presented for PCI due to angina pectoris or objective evidence of myocardial ischemia in a concordant myocardial distribution. Laser atherectomy was planned. Patients were excluded if the operator planned to utilize a DPD. Inclusion and exclusion criteria were aligned to those in the Saphenous vein graft Angioplasty Free of Emboli Randomized (SAFER) trial.
  
  
  RESULTS
  The primary end point [30-day major adverse cardiac events (MACE)] occurred in 18/98 (18.4%) patients driven primarily by non-q-wave myocardial infarction. Major procedural complications included no reflow (n=5) and major dissection (n=1). No perforations occurred. Univariate predictors of 30-day MACE included lesion length, vessel angulation, plaque burden, SVG degeneracy score, number of laser pulses used, and larger-sized laser catheters.
  
  
  CONCLUSIONS
  This study demonstrated that Excimer laser atherectomy of diseased SVGs is feasible with results comparable to the 30-day MACE in the control population from the SAFER trial. Whether the addition of laser to embolic protection devices is of any clinical utility remains to be tested in future studies.
authors.affiliation: Baystate Medical Center, 759 Chestnut St., Springfield, MA 01199, USA. Gregory.giugliano@bhs.org
authors.forename: Gregory R
authors.initials: GR
authors.lastname: Giugliano
authors.forename: M Wayne
authors.initials: MW
authors.lastname: Falcone
authors.forename: David
authors.initials: D
authors.lastname: Mego
authors.forename: Doug
authors.initials: D
authors.lastname: Ebersole
authors.forename: Steve
authors.initials: S
authors.lastname: Jenkins
authors.forename: Tony
authors.initials: T
authors.lastname: Das
authors.forename: Esmund
authors.initials: E
authors.lastname: Barker
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Ruggio
authors.forename: Brijeshwar
authors.initials: B
authors.lastname: Maini
authors.forename: Steven R
authors.initials: SR
authors.lastname: Bailey
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000379:methods*; D017225:Atherectomy, Coronary / Q000379:methods*; D017023:Coronary Angiography; D005260:Female; D005500:Follow-Up Studies; D006083:Graft Occlusion, Vascular / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D053685:Laser Therapy / Q000379:methods*; D008297:Male; D017202:Myocardial Ischemia / Q000601:surgery*; D011446:Prospective Studies; D012086:Reoperation / Q000379:methods; D012501:Saphenous Vein / Q000601:surgery* / Q000637:transplantation; D016896:Treatment Outcome