Excimer and holmium yttrium aluminum garnet laser coronary angioplasty

Recently access to the coronary arteries became available to laser angioplasty because of a new technique utilizes a pulsed laser source and multifiber, "over-the-wire" guided catheters. The aim of this study was to evaluate the early and long-term results and the side effects of coronary angioplasty with an excimer or a Ho-YAG laser. Forty consecutive patients were treated with the Ho-YAG laser (group I) and 46 consecutive patients were treated with the excimer laser (group II). The primary laser angioplasty success rate was 55% and 72% (NS) for groups I and II, respectively. This success rate was highest in saphenous vein grafts. It was similar in calcified and noncalcified lesions and in total occlusions and stenoses. It tended to be lower in long lesions than in short ones (40% vs 60%; p < 0.05 and 44% vs 78%; NS for groups I and II, respectively). Laser stand-alone therapy was performed in 5% of patients in group I compared with 22% in group II (p < 0.05). Failures were due to the inability of the laser catheter tip to reach the lesion, to cross the obstruction, or to obtain a significant reduction in stenosis. They were more frequent in patients in group I than in those in group II (45% vs 28%). There were no deaths, no myocardial infarctions, and no need for emergency coronary artery bypass grafting because most patients had total occlusions or a well-protected coronary artery. Complications included acute closure in 8% of patients in group I and in 17% of patients in group II and spasm in 10% and 13% of patients in groups I and II, respectively. Dissection occurred more frequently in patients in group II than in those in group I (28% vs 7%; p < 0.04). The angiographic patency rate at 6-month follow-up was 33% and 29% for patients groups I and II, respectively. Multifiber, wire-guided catheters provide easy access to the coronary arteries. Excimer laser angioplasty is effective but induces a high rate of dissections. Technical improvements are required to ablate more tissue to possibly reduce the restenosis rate. Further studies are needed to elucidate the mechanism of side effects and to reduce the restenosis rate.