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Published on: February 16, 2016
Laser-assisted coronary angioplasty in patients with severely depressed left ventricular function: quantitative
O Topaz1, E A Rozenbaum, M G Luxenberg
1Cardiac Catheterization Laboratory, St. Paul Ramsey Medical Center, University of Minnesota Medical School, USA.
Insights
Holmium:YAG laser angioplasty is safe and effective for high-risk patients with impaired left ventricular (LV) function and complex coronary stenoses. This laser-assisted procedure achieved high success rates and low complications in patients with reduced LV ejection fraction.
Area of Science:
- Interventional Cardiology
- Cardiovascular Medicine
- Medical Technology
Background:
- Percutaneous revascularization for complex coronary artery stenoses in patients with severely impaired left ventricular (LV) function carries high risks with traditional balloon angioplasty.
- Laser-assisted angioplasty offers a potential alternative for lesions unsuitable for balloon angioplasty, particularly in high-risk patient groups.
Purpose of the Study:
- To evaluate the feasibility, safety, and acute clinical outcomes of holmium:YAG laser-facilitated coronary angioplasty.
- To assess the efficacy of this technique in patients with severely impaired left ventricular ejection fraction (LVEF) compared to those with preserved LVEF.
Main Methods:
- Retrospective analysis of 112 patients (129 lesions) undergoing laser-facilitated angioplasty followed by balloon angioplasty.
- Patients were stratified into two groups based on LVEF: Group I (LVEF ≤ 40%) and Group II (LVEF > 40%).
- Procedural success, quantitative coronary angiography (QCA) measurements, and complication rates were compared between groups.
Main Results:
- 100% procedural success was achieved in Group I (impaired LV function) versus 93% in Group II (preserved LV function) (P=NS).
- Significant improvements in minimal lumen diameter and stenosis severity were observed in both groups post-procedure.
- Overall complication rates were low and comparable between groups, with no deaths or perforations reported; emergency CABGS was 0% in Group I.
Conclusions:
- Holmium:YAG laser-facilitated coronary angioplasty is a safe and feasible option for patients with severe LV dysfunction and complex coronary stenoses.
- The procedure demonstrates high efficacy and a low complication profile, comparable to patients with preserved LV function.
Abstract:
Laser-assisted coronary angioplasty can be successfully applied to lesions not ideal for balloon angioplasty. Patients with severely impaired left ventricular (LV) function and complex coronary artery stenoses who call for percutaneous revascularization are considered a high risk group for balloon angioplasty. In order to determine the feasibility, safety, and acute clinical outcome of a solid state, pulsed wave, mid-infrared (2.1 micron) laser facilitated angioplasty in these patients, data from 112 patients with 129 lesions were analyzed. Patients were identified according to angiographic LV function; group I included 22 patients with left ventricular ejection fraction (LVEF) < or = 40% (mean = 25% +/- 10%) and group II included 90 patients with LVEF > or = 40% (mean = 58% +/- 8%). No difference in age, gender, diabetes, hypertension, tobacco use, history of previous coronary artery bypass surgery (CABGS) or percutaneous transluminal coronary angioplasty was registered between the two groups. Multivessel disease, previous myocardial infarction (MI), and severe angina were more prevalent among group I patients (P = 0.03). No difference was found in lesion location, complexity, length, or calcification between the two groups; although group I had more eccentric lesions. Both groups were treated with the same laser energy level followed by adjunctive balloon angioplasty. One hundred percent procedural success was obtained in group I versus 93% in group II (P = NS). By Q.C.A. (independent core lab), minimal luminol diameter increased in group I from 0.9 +/- 0.5 mm preprocedure to 2.0 +/- 0.5, as compared to 0.8 +/- 0.5 mm to 1.9 +/- 0.5 mm (P = NS) in group II. Stenosis severity improved from 69% +/- 16% preprocedure to 37% +/- 13% postprocedure in group I, as compared to improvement from 78% +/- 16% to 37% +/- 12.7% in group II (P = NS). Overall complication rate was remarkably low, with no death or perforation in either group; emergency CABGS 0% in group I and 1.1% in group II; dissections 4.5% in group I and 8.8% in group II. There was no significant difference in complication rate between the two groups. The results of this study suggest that holmium:YAG laser facilitated coronary angioplasty can be safely performed in patients with severe LV dysfunction, achieving a remarkably high procedural success and low complication rate.
