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Published on: November 24, 2014
Revascularization of chronic coronary artery occlusions using laser debulking followed by stent implantation
Erhan Babalik1, Tevfik Gürmen, Murat Gülbaran
1University of Istanbul, Institute of Cardiology, Haseki, Istanbul, Turkey. erhanbabalik@yahoo.com
Insights
Laser debulking before stent implantation did not improve outcomes for chronic total occlusions. High rates of restenosis and revascularization suggest this approach is not beneficial.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Medicine
Background:
- Chronic total occlusions (CTOs) present challenges for percutaneous balloon angioplasty due to low success and high restenosis rates.
- Stent implantation following CTO recanalization improves outcomes compared to balloon angioplasty.
- The benefit of adjunctive laser debulking before stenting in CTOs remains unclear.
Purpose of the Study:
- To evaluate the efficacy of laser debulking followed by stent implantation in treating chronic total occlusions.
- To assess the impact of laser debulking on procedural success, clinical outcomes, and angiographic restenosis in CTOs.
Main Methods:
- A retrospective analysis of 48 patients with CTOs treated with laser angioplasty and subsequent stent implantation.
- Procedural success, in-hospital complications (myocardial infarction), and 6-month clinical and angiographic follow-up were analyzed.
Main Results:
- Successful guidewire crossing and procedure completion in 95.8% of patients.
- In-hospital myocardial infarction occurred in 10.8% of patients.
- At 6-month follow-up, 19.5% required repeat angioplasty, and 44% showed significant stent restenosis.
Conclusions:
- Laser debulking prior to stent implantation did not improve clinical or angiographic outcomes in patients with chronic total occlusions.
- High rates of restenosis and target vessel revascularization suggest this combined approach is not advantageous for CTOs.
Objective:
Chronic total occlusions are considered unfavourable for percutaneous balloon angioplasty because of the low rate of success and the high rate of restenosis. Stent implantation after recanalization of chronic total occlusions has been shown to reduce restenosis and reocclusion rates compared with balloon angioplasty in recently published randomized trials. However, it is not well known whether laser debulking before stent implantation would improve the benefit of stenting in chronic total occlusions.
Methods And Results:
We analysed procedural and long-term clinical and angiographic follow-up results of 48 patients who underwent laser angioplasty followed by stent implantation for chronic total occlusions. The procedure was completed successfully in 46 patients (95.8%) in whom the lesion was crossed with a guidewire. We implanted 51 stents in 46 chronic total occlusions following laser debulking. During in-hospital follow-up 1 patient (2.1%) had Q wave, and 4 patients (8.7%) had non-Q wave myocardial infarction. Nine patients (19.5%) had repeat angioplasty for restenosis and one (2.1%) underwent coronary bypass operation at 6 months follow-up. Death or Q wave myocardial infarction did not occur during 6-month follow-up. Thirty-nine patients (85%) had angiographic follow-up at 6 months, and stent restenosis was found in 17 (44%) patients.
Conclusion:
These high rates of restenosis and target vessel revascularization in our study suggest that laser debulking before stent implantation does not improve clinical and angiogragic outcomes in chronic total occlusions.
