Laser Angioplasty Followed by Stent Implantation in Chronic Coronary Occlusions: Long-term Clinical and Quantitative Angiographic Results [Turk Kardiyol Dern Ars]
Turk Kardiyol Dern Ars. 2002; 30(3): 166-171

Laser Angioplasty Followed by Stent Implantation in Chronic Coronary Occlusions: Long-term Clinical and Quantitative Angiographic Results

Erhan BABALIK1, Tevfik GÜRMEN1, Murat GÜLBARAN1, Servet ÖZTÜRK1, Muzaffer ÖZTÜRK1

Chronic coronary occlusions (CCO) are considered unfavorable for percutaneous balloon angioplasty because of low rate of success and high rate of restenosis. Stent implantation after recanalization of CCO has been shown to reduce restenosis and reocclusion rates compared with balloon angioplasty in recently published randomized trials. However, it is not well known whether laser debulking before stent implantation would further improve stenting benefit in CCO. Thus, we prospectively analyzed the procedural and long-term clinical and quantitative angiographic follow-up results of 35 patients who underwent laser angioplasty followed by stent implantation for CCO between June 1997 and February 2000. The procedure was completed successfully without any major cardiac event in 34 patients in whom the lesion was successfully crossed with a guidewire, but in one patient (3%) the procedure was unsuccessful. Thus, the rate of success was 97%. Thirty-six stents were implanted in 34 CCO lesions following laser debulking. Non-Q wave myocardial infarction developed in 2 (6%) patients during the in hospital follow-up period. Treadmill test was positive in 9 (27%) patients after six months follow-up. Seven (20%) of them had repeat angioplasty for restenosis and one (3%) underwent coronary bypass surgery. Death or Q wave myocardial infarction did not occur during follow-up period, and event-free survival rate was 77%. Twenty-eight (83%) patients had angiographic follow-up six months after the procedure; the mean reference vessel diameter was 2.7 mm in quantitative analysis and restenosis was found in 14 (50%) patients.In conclusion; the procedural success rate is high, but the restenosis and target vessel revascularization rates were also high in our patients who underwent laser debulking followed by stent implantation for CCO lesions. Relatively small vessel size (2.7 mm in diameter) and and the mean 24 mm-stent length may explain these high rates of restenosis and of repeat procedure in our patient population. In addition, 5 (14%) of CCO lesions had ostial location, might further contribute these disappointing results. We need large scale randomized trials detecting effect of laser debulking before stent implantation in CCO lesions.


How to cite this article
Erhan BABALIK, Tevfik GÜRMEN, Murat GÜLBARAN, Servet ÖZTÜRK, Muzaffer ÖZTÜRK. Laser Angioplasty Followed by Stent Implantation in Chronic Coronary Occlusions: Long-term Clinical and Quantitative Angiographic Results. Turk Kardiyol Dern Ars. 2002; 30(3): 166-171
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