Restenosis of the coronary stenotic lesions treated by holmium:YAG laser coronary angioplasty

摘要

Abstract: Clinical efficacy of newly developed Holmium YAG laser coronary angioplasty (HLCA) was assessed for 30 patients with angina. There were 12 near left main trunk (LMT) lesions and 4 aorto- ostial lesions. Adjunctive balloon angioplasty was performed for 25 of 30 lesions. Delivered energy ranged from 1.5 to 2.5 watts/pulse and the total exposure time ranged from 6 to 55 seconds. External diameter of laser catheter was 1.5 mm for 13 lesions, 1.4 mm for 17 lesions, and 1.7 mm for 5 lesions. Laser success, defined as 20% reduction of stenotic ratio, was obtained in 21 of 30 (70%) and overall procedural success rate was 93%. There were 3 cases with acute coronary occlusions relieved by adjunctive balloon angioplasty and one coronary perforation without manifestation of cardiac tamponade. There were no large coronary dissection which involved more than 5 mm of the coronary artery. Follow up coronary angiography after 3 months showed restenosis in 14 of 27 patients (52%). Percent stenosis after lasering (56%) was similar to that at 3 months after (62%). HLCA is acutely effective treatment for lesions near LMT, because of low incidence of large coronary dissection. However, angiographical restenosis rate is high at 3 months after HLCA. This may be attributed to the relatively large residual stenosis after the procedure and vessel injury caused by shock wave. !9