| Recanalization of chronic total coronary occlusions using a laser guide wire: a pilot study. | |
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MedLine Citation:
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PMID: 9283521 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVES: This study sought to prospectively evaluate the performance of a laser guide wire in crossing chronic total coronary occlusions in patients with a failed previous mechanical guide wire attempt. BACKGROUND: Despite continued refinement of mechanical hardware available for coronary angioplasty, restoration and maintenance of blood flow through a chronically occluded coronary artery remains a true challenge. METHODS: Fifty patients with a chronic total coronary occlusion and a previous failed attempt at recanalization using mechanical guide wires were included. A mechanical attempt to cross the occlusion was repeated. In case of failure, an additional attempt was made with the laser guide wire. RESULTS: The median age of occlusion was 22 weeks (range 5 to 200), and the occlusion length was 23 +/- 11 mm (mean +/- SD). A repeat mechanical attempt was successful in six cases (12%). Dissection occurred in five other cases, and device crossover was not attempted. Thus, in 39 patients an attempt was made with the laser guide wire, with successful recanalization in 23 (59%). Thereby the overall success rate increased from 12% to 58% (29 of 50 patients). The amount of contrast medium used was 515 +/- 154 ml, fluoroscopy time was 99 +/- 43 min, and total procedure time was 2 h 48 min (+/- 55 min). Procedural success was achieved in 26 cases and clinical success (procedural success without in hospital events) in 24. In-hospital events were two non-Q wave myocardial infarctions related to subacute reocclusion. In one patient, a balloon dilation after laser guide wire perforation resulted in tamponade requiring pericardiocentesis. After a successful procedure, the angina class decreased from 2.9 +/- 0.2 to 1.4 +/- 0.7 at 3 months of clinical follow-up. Six month angiographic follow-up was completed in all 24 eligible patients and showed vessel patency in 20 (80%). CONCLUSIONS: The use of the laser guide wire for recanalization of chronic total coronary occlusions refractory to treatment with mechanical guide wires is feasible and relatively safe and was successful in 59% of cases. This device must thus be considered a valuable addition to the interventional armamentarium and accordingly will be evaluated in a randomized clinical trial. |
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Authors:
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J N Hamburger; G H Gijsbers; Y Ozaki; P N Ruygrok; P J de Feyter; P W Serruys |
Publication Detail:
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Type: Clinical Trial; Journal Article |
Journal Detail:
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Title: Journal of the American College of Cardiology Volume: 30 ISSN: 0735-1097 ISO Abbreviation: J. Am. Coll. Cardiol. Publication Date: 1997 Sep |
Date Detail:
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Created Date: 1997-09-18 Completed Date: 1997-09-18 Revised Date: 2007-11-15 |
Medline Journal Info:
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Nlm Unique ID: 8301365 Medline TA: J Am Coll Cardiol Country: UNITED STATES |
Other Details:
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Languages: eng Pagination: 649-56 Citation Subset: AIM; IM |
Affiliation:
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Thoraxcenter, University Hospital Rotterdam, The Netherlands. hamburge@card.azr.nl |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Angioplasty, Transluminal, Percutaneous Coronary
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instrumentation* Coronary Disease / therapy* Female Follow-Up Studies Humans Laser Therapy* Lasers / adverse effects Male Middle Aged Pilot Projects Prospective Studies Stents |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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