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Titolo:
EARLY AND LATE QUANTITATIVE ANGIOGRAPHIC RESULTS OF VEIN GRAFT LESIONS TREATED BY EXCIMER-LASER WITH ADJUNCTIVE BALLOON ANGIOPLASTY
Autore:
STRAUSS BH; NATARAJAN MK; BATCHELOR WB; YARDLEY DE; BITTL JA; SANBORN TA; POWER JA; WATSON LE; MOOTHART R; TCHENG JE; CHISHOLM RJ;
Indirizzi:
UNIV TORONTO,ST MICHAELS HOSP,DIV CARDIOL,30 BOND ST TORONTO ON M5B 1W8 CANADA ST ANTHONYS MED CTR ROCKFORD IL 00000 BRIGHAM & WOMENS HOSP,DEPT MED BOSTON MA 02115 HARVARD UNIV,SCH MED BOSTON MA 00000 CORNELL UNIV,NEW YORK HOSP,DEPT MED NEW YORK NY 00000 ST FRANCIS HOSP,DEPT MED PITTSBURGH PA 00000 SCOTT & WHITE MEM HOSP & CLIN TEMPLE TX 76508 PENROSE COMMUNITY HOSP COLORADO SPRINGS CO 00000 DUKE UNIV,MED CTR,DEPT MED DURHAM NC 27710
Titolo Testata:
Circulation
fascicolo: 3, volume: 92, anno: 1995,
pagine: 348 - 356
SICI:
0009-7322(1995)92:3<348:EALQAR>2.0.ZU;2-Z
Fonte:
ISI
Lingua:
ENG
Soggetto:
LUMINAL CORONARY ANGIOPLASTY; PLACEBO-CONTROLLED TRIAL; RELATIVE RISK ANALYSIS; ARTERY BYPASS GRAFTS; TERM FOLLOW-UP; DIRECTIONAL ATHERECTOMY; DOUBLE-BLIND; RESTENOSIS; SURGERY; EXPERIENCE;
Keywords:
BYPASS; LASERS; ANGIOPLASTY; RESTENOSIS; CORONARY DISEASE;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Science Citation Index Expanded
Science Citation Index Expanded
Citazioni:
54
Recensione:
Indirizzi per estratti:
Citazione:
B.H. Strauss et al., "EARLY AND LATE QUANTITATIVE ANGIOGRAPHIC RESULTS OF VEIN GRAFT LESIONS TREATED BY EXCIMER-LASER WITH ADJUNCTIVE BALLOON ANGIOPLASTY", Circulation, 92(3), 1995, pp. 348-356

Abstract

Background Percutaneous excimer laser coronary angioplasty (PELCA) has been approved for treatment of diseased saphenous vein bypass grafts. However, detailed and complete quantitative angiographic analysis ofimmediate procedural and late follow-up results has not been performed. Methods and Results PELCA using the CVX-300 excimer laser system was performed in 125 bypass lesions (mean graft age, 96+/-53 months; range, 2 to 240 months) in 106 consecutive patients at eight centers. Quantitative analyses of the procedural and follow-up angiograms were done with the Cardiac Measurement System. Stand-alone PELCA was done in 21 lesions (17%). Lesions were located at the ostium (20%), body (67%),or distal anastomosis (13%). The graft reference diameter was 3.26+/-0.79 mm (mean+/-SD). Minimal lumen diameter increased from 1.09+/-0.52mm before treatment to 1.61+/-0.69 mm after laser and 2.18+/-0.63 mm after adjunctive balloon dilation (P<.001) but had declined at follow-up to 1.40+/-1.17 mm. Dissections were evident in 45% of lesions afterlaser treatment (types A and B, 27%; types C through F, 18%), including 7% occlusions. Angiographic success (less than or equal to 50% diameter stenosis [% DS]) was 54% after laser and 91% after adjunctive PTCA, with an overall clinical success rate of 89%. In-hospital complications were death, 0.9%; myocardial infarction (Q-wave and non-Q-wave), 4.5%; and bypass surgery, 0.9%. Independent predictors of % DS after laser were reference diameter, lesion length, and minimal lumen diameter before laser. At angiographic follow-up in 83% of eligible patients,the restenosis rate per lesion (DS >50%) was 52%, including 23 occlusions (24%). The only independent predictor of increased % DS at follow-up was lesion symmetry. Logistic regression indicated that smaller reference diameter was an independent predictor of late occlusion. Overall 1-year mortality was 8.6%. Actuarial event-free survival (freedom from death, myocardial infarction, bypass surgery, or target vessel percutaneous transluminal coronary angioplasty) was 48.2% at 1 year. Conclusions Excimer laser angioplasty with adjunctive balloon angioplasty can be safely and successfully performed in diseased, old saphenous vein bypass graft lesions considered at high risk for reintervention. The extent of laser ablation remains limited by the diameter and effectiveness of the catheters. Late restenosis and, in particular, total occlusion mitigate the early benefits of the procedure. Other approaches such as the routine use of additional anticoagulation (eg, warfarin) should be considered to reduce the risk of late occlusions and restenosis after laser angioplasty of bypass grafts.

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Documento generato il 26/11/20 alle ore 08:28:28