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Application of excimer laser angioplasty in acute myocardial infarction
1Division of Cardiology, McGuire VA Medical Center, Medical College of Virginia Hospitals, 1201 Broad Rock Road, Richmond, VA 23249, USA.
Insights
Excimer laser coronary angioplasty (ELCA) effectively treats acute myocardial infarction in patients unresponsive to or ineligible for thrombolytics. This laser therapy safely dissolves coronary thrombus, improving outcomes without adverse events.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Laser Technology in Medicine
Background:
- Acute myocardial infarction (AMI) patients unresponsive to thrombolytics or with contraindications require mechanical revascularization.
- Excimer laser angioplasty utilizes ultraviolet wavelength (308 nm) energy, absorbed by both thrombi and atherosclerotic plaques.
- This study investigates the feasibility and safety of excimer laser coronary angioplasty (ELCA) in complicated AMI cases.
Purpose of the Study:
- To evaluate the feasibility and safety of excimer laser coronary angioplasty (ELCA) in selected patients with acute myocardial infarction (AMI).
- To assess ELCA's efficacy in patients who failed thrombolytic therapy or had contraindications.
- To determine the impact of ELCA on intracoronary thrombus dissolution and procedural success.
Main Methods:
- Fifty patients with complicated AMI underwent percutaneous excimer coronary laser angioplasty (ELCA) for 54 obstructive lesions.
- Patients included those with continuous chest pain, ischemia, Q-wave or non-Q-wave MI, reduced ejection fraction, and cardiogenic shock.
- Adjunct balloon dilation and stenting were performed post-laser debulking; quantitative coronary arteriography (QCA) assessed results.
Main Results:
- Achieved 98% laser success and 100% procedural success, significantly increasing minimal luminal diameter and reducing stenosis.
- Reduced thrombus burden by 83% and improved TIMI flow, with no deaths, emergency bypass surgery, or major complications.
- All 50 patients survived, showed clinical improvement, and were discharged following successful ELCA and adjunct procedures.
Conclusions:
- Excimer laser coronary angioplasty (ELCA) is a feasible and safe treatment option for selected acute myocardial infarction patients.
- ELCA effectively dissolves intracoronary thrombus without negatively impacting procedural outcomes.
- This laser therapy offers a viable alternative for patients with contraindications or resistance to thrombolytic agents.
Background And Objective:
Patients presenting with acute myocardial infarction who fail to respond to standard therapy with thrombolytics or have contraindications for their use oftentimes need revascularization with a mechanical device for removal of an occlusive coronary thrombus and its underlying atherosclerotic plaque. As both thrombi and plaques absorb laser energy in the ultraviolet wavelength (308 nm), we studied the feasibility and safety of excimer laser angioplasty in selective patients with complicated acute myocardial infarction.
Study Design/Materials And Methods:
Fifty patients with acute myocardial infarction complicated by continuous chest pain and/or ischemia who had a total of 54 obstructive lesions were treated with percutaneous excimer coronary laser angioplasty (ELCA). A Q-wave myocardial infarction was documented in 56% and a non-Q-wave myocardial infarction in 44%. The baseline left ventricular ejection fraction was reduced at 43 +/- 13% and six patients (12%) presented to the cardiac catheterization laboratory in cardiogenic shock. Twenty-nine patients failed to respond to thrombolytic therapy and 16 had contraindications for thrombolytics and IIb/IIIa receptor antagonists. Following laser debulking, all patients received adjunct balloon dilation and then stents were deployed in 83% of the target lesions. Quantitative coronary arteriography (QCA) was performed at an independent core laboratory.
Results:
Ninety-eight percent laser success and 100% procedural success were achieved. By QCA the minimal luminal diameter increased from baseline of 0.7 +/- 0.5 to 1.3 +/- 0.5 mm post-lasing and then to 2.0 +/- 0.6 with balloon dilation to a final of 3.0 +/- 0.5 mm. Pre-laser percent stenosis diameter of 77 +/- 17% was reduced to 51 +/- 22% post-laser to 3.0 +/- 17% post-balloon and to a final of 15 +/- 25%. An 83% laser-induced reduction of thrombus burden area was achieved as well as an increase in TIMI flow from baseline of 1.7 +/- 1.1 to 2.8 +/- 0.4 by laser to a 2.9 +/- 0.4 final. There were no deaths, emergency bypass surgery, cerebral vascular accident, neurologic injury, or major perforation. In one case, a laser-induced major dissection was successfully treated by stenting. All 50 patients survived the procedure, improved clinically, and were discharged.
Conclusion:
Application of excimer laser coronary angioplasty is feasible and safe in selected patients with acute myocardial infarction who either fail to respond to thrombolytics or have contraindications to these agents. Intracoronary thrombus at the target lesion can be successfully dissolved with this wavelength laser energy without adverse effect on the procedure results.
