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Excimer laser-assisted coronary angioplasty for lesions containing thrombus
P Estella1, T J Ryan, J S Landzberg
1Department of Medicine, Brigham and women's Hospital, Harvard Medical School, Boston, Massachusetts 02115.
Insights
Excimer laser-assisted coronary angioplasty success rates are significantly lower in patients with intracoronary thrombus. New strategies are needed to improve outcomes for this high-risk group.
Area of Science:
- Cardiovascular Interventions
- Interventional Cardiology
- Laser Angioplasty
Background:
- Intracoronary thrombus presence elevates risks post-balloon angioplasty.
- The impact of thrombus on excimer laser-assisted coronary angioplasty (ELCA) remains unclear.
Purpose of the Study:
- To evaluate the success rates of ELCA in patients with and without intracoronary thrombus.
- To assess the safety and efficacy of ELCA in the presence of coronary artery thrombus.
Main Methods:
- 142 patients underwent percutaneous ELCA.
- 12 patients had lesions with angiographically confirmed intracoronary thrombus (defined as filling defect or contrast staining).
Main Results:
- Clinical success was achieved in 58% of patients with thrombus versus 95% without (p=0.00001).
- Complications like embolization (25% vs 1%) and myocardial infarction (33% vs 2%) were higher in the thrombus group.
- Intracoronary thrombus was the strongest predictor of lower clinical success (p=0.013).
Conclusions:
- ELCA success is compromised by the angiographic presence of intracoronary thrombus.
- Improved strategies are essential for better angioplasty outcomes in patients with coronary thrombus.
Objectives:
The purpose of this study was to analyze the success rates for excimer laser-assisted coronary angioplasty performed in patients undergoing angioplasty for lesions containing thrombus.
Background:
The presence of intracoronary thrombus increases the risk of a poor clinical outcome after balloon angioplasty. The effect of intracoronary thrombus on the safety and efficacy of excimer laser-assisted coronary angioplasty is unknown.
Methods:
Percutaneous excimer laser-assisted coronary angioplasty was attempted in 142 patients, of whom 12 had angiographic evidence of intracoronary thrombus in 14 lesions, defined as a filling defect surrounded by contrast medium or an area of contrast staining.
Results:
Clinical success (< 50% residual stenosis without myocardial infarction, death or bypass surgery at any time during hospitalization) was achieved in 7 (58%) of the 12 patients with intracoronary thrombus, compared with 123 (95%) of the 130 patients without thrombus (p = 0.00001). Angiographic and clinical complications were more common in patients with thrombus: embolization (25% vs. 1%, p < 0.001), myocardial infarction (33% vs. 2%, p < 0.001), abrupt closure (17% vs. 4%, p = 0.049). Angiographic restenosis at 6 months was seen at 7 (70%) of 10 treated sites with intracoronary thrombus and at 59 (51%) of 116 sites without thrombus (p = 0.245). Presence of intracoronary thrombus was identified as the most important predictor of clinical success (p = 0.013) by multivariable logistic regression analysis, which controlled for other co-variables, such as lesion complexity or lesion location in a saphenous vein graft.
Conclusions:
This analysis shows that the success of excimer laser-assisted coronary angioplasty is compromised when thrombus is detected angiographically. Further investigation of other strategies is needed to improve the outcome of angioplasty for this challenging problem.