Angiographic Results and Elastic Recoil Following Coronary Excimer Laser Angioplasty with Saline Perfusion

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Abstract
Recent experiments have demonstrated that pressure waves of several hundred atmospheres, which occur during excimer laser coronary angioplasty (ELCA), are reduced while ablating in saline in comparison to blood or contrast medium. We report the procedural outcome of ELCA (XeCI laser operating at 308 nm, 25–40 Hz, 40–60 mJ/mm2 fluence, and 135 nsec/pulse) performed with a modified saline infusion protocol (two operator technique, flush, and continuous application of saline through the guiding catheter immediately prior and during the whole losing procedure). We studied 48 patients (34 males, 14 females; mean age: 61 ± 6 years; 18 occlusions, 30 stenoses [> 60% diameter stenosis]) with 10 type A, 17 type B, and 21 type C lesions. Laser success (> 20% increase in minimal luminal diameter [MLD]) was achieved in 41 patients (85.4%), and procedural success (< 50% residual stenosis) in 44 patients (91.6%). The MLD increased from 0.37 ± 0.12 to 1.63 ± 0.35 mm (P < 0.001) following laser ablation, and to 2.30 ± 0.34 mm (P > 0.01) after percutaneous transluminal coronary angioplasty (PTCA). The mean percentage stenosis decreased from 81%± 6% (baseline) to 48%± 12% (P < 0.001) after laser ablation, and to 29%± 10% (P < 0.01) following PTCA. The mean diameter of the laser‐catheter (LC) was 1.54 ± 0.2 and the mean diameter of the inflated balloon at maximum pressure was 2.7 ± 0.25 mm. Thus, the elastic recoil (ER) following balloon deflation was 15%± 9%, and below the reported ER for PTCA. Two major dissections occurred following ELCA; one patient required bypass surgery and developed a Q wave myocardial infarction (Ml), and one patient was successfully treated with stent implantation following abrupt closure. There were no in‐hospital deaths, further Q wave MIs, and/or perforation. In conclusion, ELCA with concomitant saline infusion is effective, safe, and easy to perform. The use of this ablation procedure reduces the rate of significant dissections, favors effective tissue ablation, and thus may in part be responsible for a reduced amount of elastic recoil following additional balloon angioplasty. (J Interven Cardiol 1996;9:9–18)