Chronic total obstruction and short-term outcome: the Excimer Laser Coronary Angioplasty Registry experience.

Percutaneous transluminal coronary angioplasty for chronic total obstructions is associated with significantly decreased success rates in comparison with those for dilation of subtotal stenoses. Failure usually results from inability to cross the occlusive lesion with a guidewire, although it may result from inability to pass the balloon catheter after the guidewire has been passed. In the Excimer Laser Coronary Angioplasty Registry, 172 chronic total obstructions were treated in 162 patients (10.3% of the 1,569 patients entered). For chronic total obstructions, passage of a guidewire is a prerequisite for laser angioplasty. Once a guidewire crossed an occlusion, the overall laser success rate for treatment of chronic total obstructions was 83%; the extent of stenosis decreased from 100% to 55 +/- 26%. Success was independent of length of the occlusive lesion. In 74% of patients, adjunctive percutaneous transluminal coronary angioplasty was used after laser angioplasty. A final procedural success, defined as residual stenosis of less than 50% and no major complication (coronary artery bypass grafting, myocardial infarction, or death), was achieved in 90%. Major complications were infrequent; 1.2% of patients required coronary artery bypass grafting, and 1.9% had a Q-wave myocardial infarction. Only one death occurred. The use of laser angioplasty may be of particular value when chronic total obstructions can be crossed with a guidewire but not with a conventional balloon catheter or when the occlusion is confirmed to be extremely long.

Percutaneous excimer laser coronary angioplasty: results of one center in a multi-center investigation.

A retrospective analysis of data accumulated over a 21-month period, from December 1989 to September 1991, regarding investigational use of a 308 nanometer Xenon Chloride Excimer Laser Coronary Angioplasty (ELCA) system (Advanced Interventional Systems, Inc., Irvine, CA) was performed. It included a cohort of 131 persons with coronary artery disease who underwent 158 laser angioplasty procedures for attempted treatment of a total of 206 atherosclerotic lesions. Approximately 17% of the lesions treated with ELCA were chronic occlusions, 20% were diffuse lesions greater than 20 mm in length and 30% of the initial ELCA lesions were restenoses of previous balloon-treated sites. Our initial results with ELCA demonstrate similar rates of success, complication, mortality, and restenosis when compared with the larger historical experience with standard coronary balloon technique. In selected subgroups, such as chronically occluded coronary lesions, the acute success rate when using ELCA appears superior to published success rates when similar lesions have been treated with conventional technology.