title: Case-control registry of excimer laser coronary angioplasty versus distal protection devices in patients with acute coronary syndromes due to saphenous vein graft disease.
abstract: Laser atherectomy might decrease procedural complications during percutaneous coronary intervention (PCI) of degenerated saphenous vein grafts (SVGs) in case of unstable or thrombotic lesions because of its ability to debulk and vaporize thrombus. We aimed at prospectively evaluating the safety and efficacy of excimer laser coronary angioplasty (ELCA) as a primary treatment strategy in consecutively unstable patients undergoing PCI of degenerated SVG lesions. Seventy-one consecutive patients with non-ST elevation acute coronary syndrome (mean age 69 ± 10 years, 66 men [89%]) undergoing PCI of degenerated SVG were enrolled in a prospective case-control registry, using 2 different distal protection devices (DPDs; FilterWire EZ [Boston Scientific, Natick, Massachusetts; n = 24] and SpiderRX [Ev3, Plymouth, Minnesota; n = 23]) or ELCA (n = 24). Primary end points of the study were incidence of angiographic microvascular obstruction (Thrombolysis In Myocardial Infarction flow grade of <3 or Thrombolysis In Myocardial Infraction flow grade of 3 with myocardial blush grade 1 to 2) and incidence of type IVa myocardial infarction. Angiographic microvascular obstruction incidence tended to be less in ELCA-treated patients compared with DPD-treated patients (3 [13%] vs 15 [32%], p = 0.09). Type IVa myocardial infarction incidence was more in DPD-treated patients compared with ELCA-treated patients (23 [49%] vs 5 [21%], p = 0.04). In conclusion, in patients with non-ST elevation acute coronary syndrome undergoing PCI of degenerated SVG, ELCA compared with DPD, is associated with a trend for better myocardial reperfusion and a lesser incidence of periprocedural necrosis. Controlled randomized trials are warranted to confirm these early observations.
authors.affiliation: Department of Cardiovascular Medicine, Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy. Electronic address: giampaolo.niccoli@rm.unicatt.it.
authors.forename: Giampaolo
authors.initials: G
authors.lastname: Niccoli
authors.forename: Flavia
authors.initials: F
authors.lastname: Belloni
authors.forename: Nicola
authors.initials: N
authors.lastname: Cosentino
authors.forename: Francesco
authors.initials: F
authors.lastname: Fracassi
authors.forename: Elena
authors.initials: E
authors.lastname: Falcioni
authors.forename: Marco
authors.initials: M
authors.lastname: Roberto
authors.forename: Roberta Antonazzo
authors.initials: RA
authors.lastname: Panico
authors.forename: Rocco
authors.initials: R
authors.lastname: Mongiardo
authors.forename: Italo
authors.initials: I
authors.lastname: Porto
authors.forename: Antonio Maria
authors.initials: AM
authors.lastname: Leone
authors.forename: Francesco
authors.initials: F
authors.lastname: Burzotta
authors.forename: Carlo
authors.initials: C
authors.lastname: Trani
authors.forename: Filippo
authors.initials: F
authors.lastname: Crea
mesh_terms: D054058:Acute Coronary Syndrome / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000379:methods*; D016022:Case-Control Studies; D017023:Coronary Angiography; D005260:Female; D005500:Follow-Up Studies; D006083:Graft Occlusion, Vascular / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D053685:Laser Therapy / Q000379:methods*; D054018:Lasers, Excimer / Q000627:therapeutic use*; D008297:Male; D011379:Prognosis; D011446:Prospective Studies; D012501:Saphenous Vein / Q000637:transplantation*