| Application of excimer laser angioplasty in acute myocardial infarction. | |
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MedLine Citation:
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PMID: 11553909 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND AND OBJECTIVE: Patients presenting with acute myocardial infarction who fail to respond to standard therapy with thrombolytics or have contraindications for their use oftentimes need revascularization with a mechanical device for removal of an occlusive coronary thrombus and its underlying atherosclerotic plaque. As both thrombi and plaques absorb laser energy in the ultraviolet wavelength (308 nm), we studied the feasibility and safety of excimer laser angioplasty in selective patients with complicated acute myocardial infarction. STUDY DESIGN/MATERIALS AND METHODS: Fifty patients with acute myocardial infarction complicated by continuous chest pain and/or ischemia who had a total of 54 obstructive lesions were treated with percutaneous excimer coronary laser angioplasty (ELCA). A Q-wave myocardial infarction was documented in 56% and a non-Q-wave myocardial infarction in 44%. The baseline left ventricular ejection fraction was reduced at 43 +/- 13% and six patients (12%) presented to the cardiac catheterization laboratory in cardiogenic shock. Twenty-nine patients failed to respond to thrombolytic therapy and 16 had contraindications for thrombolytics and IIb/IIIa receptor antagonists. Following laser debulking, all patients received adjunct balloon dilation and then stents were deployed in 83% of the target lesions. Quantitative coronary arteriography (QCA) was performed at an independent core laboratory. RESULTS: Ninety-eight percent laser success and 100% procedural success were achieved. By QCA the minimal luminal diameter increased from baseline of 0.7 +/- 0.5 to 1.3 +/- 0.5 mm post-lasing and then to 2.0 +/- 0.6 with balloon dilation to a final of 3.0 +/- 0.5 mm. Pre-laser percent stenosis diameter of 77 +/- 17% was reduced to 51 +/- 22% post-laser to 3.0 +/- 17% post-balloon and to a final of 15 +/- 25%. An 83% laser-induced reduction of thrombus burden area was achieved as well as an increase in TIMI flow from baseline of 1.7 +/- 1.1 to 2.8 +/- 0.4 by laser to a 2.9 +/- 0.4 final. There were no deaths, emergency bypass surgery, cerebral vascular accident, neurologic injury, or major perforation. In one case, a laser-induced major dissection was successfully treated by stenting. All 50 patients survived the procedure, improved clinically, and were discharged. CONCLUSION: Application of excimer laser coronary angioplasty is feasible and safe in selected patients with acute myocardial infarction who either fail to respond to thrombolytics or have contraindications to these agents. Intracoronary thrombus at the target lesion can be successfully dissolved with this wavelength laser energy without adverse effect on the procedure results. |
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Authors:
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O Topaz; R Shah; P K Mohanty; R A McQueen; Y Janin; N L Bernardo |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Lasers in surgery and medicine Volume: 29 ISSN: 0196-8092 ISO Abbreviation: Lasers Surg Med Publication Date: 2001 |
Date Detail:
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Created Date: 2001-09-12 Completed Date: 2001-10-18 Revised Date: 2004-11-17 |
Medline Journal Info:
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Nlm Unique ID: 8007168 Medline TA: Lasers Surg Med Country: United States |
Other Details:
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Languages: eng Pagination: 185-92 Citation Subset: IM |
Copyright Information:
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Copyright 2001 Wiley-Liss, Inc. |
Affiliation:
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Division of Cardiology, McGuire VA Medical Center, Medical College of Virginia Hospitals, 1201 Broad Rock Road, Richmond, VA 23249, USA. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Angioplasty, Balloon, Laser-Assisted* Female Humans Male Middle Aged Myocardial Infarction / surgery* |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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