Laser coronary angioplasty - Tips From Other Journals

Date: March, 1991

Recent angioscopy and autopsy studies have shown fissures in atheromata after percutaneous transluminal coronary angioplasty. It has been postulated that the increase in vascular diameter seen on angiography may be a result of stretching of the normal vascular wall in eccentric coronary lesions. Balloon inflation does not reduce the mass of atheromatous lesions. Consequently, intravascular interventions are needed to reduce the mass without disrupting normal vasculature. Litvack and associates conducted a study to determine the efficacy of excimer laser coronary angioplasty as an adjunct or alternative to conventional balloon angioplasty.

Fifty-five patients underwent a modified balloon angioplasty. The technique used a 1.6-mm diameter catheter constructed of 12 individual silica fibers arranged concentrically around a guidewire lumen. The procedure was considered successful if the stenotic diameter increased by 20 percent or more and the vessel diameter was greater than 1 mm.

In 46 (84 percent) of the patients, laser angioplasty was initially successful. Adjunctive balloon angioplasty was necessary in 41 patients (75 percent). The authors believe that the need for adjunctive angioplasty in these patients could be obviated by the use of a catheter with a larger diameter.

Stenosis as determined by quantitative angiography decreased from a mean baseline of 83 [+ or -] 14 percent to a mean of 49 [+ or -] 11 percent after laser treatment and to a mean of 38 [+ or -] 12 percent after adjunctive balloon angioplasty. There were no deaths and no vascular perforations. Only one patient required emergency coronary artery bypass surgery.

The authors suggest that percutaneous excimer laser coronary angioplasty can safely ablate atheroma and reduce coronary stenosis. (American Journal of Cardiology, November 1, 1990, vol. 66, p. 1027.)

COPYRIGHT 1991 American Academy of Family PhysiciansCOPYRIGHT 2004 Gale Group

 
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