Related Experiment Videos
In-stent restenosis. Acute and long-term outcomes after excimer laser coronary angioplasty
J Bejarano1, E Bermudez, P Diaz
1Miami Heart Institute and Medical Center, Florida 33140, USA.
Insights
Excimer laser coronary angioplasty (ELCA) effectively treats in-stent restenosis, improving vessel diameter and reducing stenosis. While safe, a slight increase in new restenosis was observed between 6 and 12 months.
Area of Science:
- Interventional Cardiology
- Vascular Medicine
- Laser Technology in Medicine
Background:
- In-stent restenosis is a significant complication of coronary stenting.
- Effective treatment strategies for in-stent restenosis are crucial for improving patient outcomes.
Purpose of the Study:
- To evaluate the short- and long-term effectiveness and safety of excimer laser coronary angioplasty (ELCA) for treating in-stent restenosis.
- To assess procedural success rates and clinical outcomes in patients undergoing ELCA for in-stent restenosis.
Main Methods:
- Retrospective analysis of 25 patients with 33 in-stent restenosis incidents treated with ELCA.
- Procedures involved ELCA followed by balloon angioplasty (PTCA) and ultrasound monitoring.
- Vessel locations included LAD, LCx, RCA, LMCA, and venous bypass grafts.
Main Results:
- ELCA demonstrated a 71% success rate, with 100% success for subsequent PTCA.
- Significant improvements were observed in minimal luminal diameter (MLD) and percent stenosis post-procedure (p < 0.001).
- At 6 months, 68% of patients were asymptomatic; at 1 year, 60% remained asymptomatic. New restenosis rates were 24.2% at 6 months and 27.3% at 12 months.
Conclusions:
- Excimer laser coronary angioplasty (ELCA) is a safe and effective treatment option for in-stent restenosis.
- The study noted a slight increase in new restenotic lesions between 6 and 12 months post-procedure.
- ELCA, combined with PTCA, offers significant luminal improvement in patients with in-stent restenosis.
Objective:
With the increased use of intracoronary stents, in-stent restenosis has become a clinically significant drawback in invasive cardiology. We retrospectively assessed the short- and long-term outcomes after excimer laser coronary angioplasty of in-stent restenosis.
Methods:
Twenty-five patients with 33 incidents of in-stent restenosis treated with excimer laser coronary angioplasty (ELCA) were analyzed. Sixty-six percent were males, mean age of 73 +/- 11 years, and 83% were functional class III-IV (NYHA). ELCA was performed using 23 concentric and 10 eccentric catheters with a diameter of 1.6-2.2 mm, followed by balloon angioplasty (PTCA) and ultrasound monitoring. The procedure was performed in the following vessels: left anterior descending artery, 10; left circumflex artery, 8; right coronary artery, 6; left main coronary artery, 2; and venous bypass graft, 7.
Results:
The ELCA was successful in 71% of the cases, and PTCA was 100% successful. The diameter of the treated vessels was 3.44 +/- 0.5 mm; the minimal luminal diameter (MLD) increased from 0.30 mm pre-ECLA to 1.97 mm post-ELCA, and to 2.94 mm post-PTCA (p < 0.001). The percent stenosis was reduced from 91.4 +/- 9.5% before ECLA to 42.3 +/- 14.9% after ELCA and to 14.6 +/- 9.3% after PTCA (p < 0.001). Seventeen (68%) patients were asymptomatic at 6 months and 15 (60%) at 1 year. New restenosis rates were 8/33 (24.2%) at 6 months and 9/33 (27.3%) at 12 months.
Conclusion:
ELCA is safe and effective for the treatment of in-stent restenosis. In the present sample, a slight increase in new restenotic lesions between 6 and 12 months was found.