Prospective, randomized, multicenter comparison of laser-facilitated balloon angioplasty versus stand-alone balloon angioplasty in patients with obstructive coronary artery disease

Gregg W. Stone, Eduardo De Marchena, David Dageforde, Alberto Foschi, Joseph B. Muhlestein, Michael McIvor, David Rizik, Ronald Vanderlaan, Joann McDonnell

Research output: Contribution to journalArticlepeer-review

24 Scopus citations

Abstract

Objectives. The goal of this study was to examine the relative safety and efficacy of laser-facilitated percutaneous transluminal coronary angioplasty (PTCA) versus 'stand-alone' PTCA. Background. Plaque debulking with lasing before PTCA may result in improved lumen dimensions and decreased rates of periprocedural ischemic complications, thus improving short-and long-term outcomes after percutaneous intervention. The mid-infrared holmium:yttrium-aluminum-garnet (YAG) laser has been shown to be effective in a variety of plaque subtypes and may be particularly useful in high risk acute ischemic syndromes. Methods. A total of 215 patients (mean [ ± SD] age 61 ± 12 years) with 244 lesions were prospectively randomized at 14 clinical centers to laser versus stand-alone PICA. After laser treatment, all patients underwent PICA; 148 patients (69%) had unstable angina. Results. The procedural success rate without major catheterization laboratory complications was similar in patients assigned to laser treatment or PTCA alone (96.6% vs. 96.9%, p = 0.88), as was the in-hospital clinical success rate (89.7% vs. 93.9%, p = 0.27). There was no difference in postprocedural diameter stenosis after laser treatment compared with PTCA (18.3% ± 13.6% vs. 19.5% ± 15.1%, p = 0.50). However, use of the laser, versus PICA alone, did result in significantly more major and minor procedural complications (18.0% vs. 3.1%, p = 0.0004), myocardial infarctions (4.3% vs. 0%, p = 0.04) and total in-hospital major adverse events (10.3% vs. 4.1%, p = 0.08). At a mean follow-up time of 11.2 ± 7.7 months, there were no differences in late or event-free survival in patients assigned to laser treatment versus PICA alone. Conclusions. Compared with stand-alone PTCA, laser-facilitated FICA results in a more complicated hospital course, without immediate or long- term benefits.

Original languageEnglish (US)
Pages (from-to)1714-1721
Number of pages8
JournalJournal of the American College of Cardiology
Volume30
Issue number7
DOIs
StatePublished - Dec 1997

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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