Short-term results and intermediate-term follow-up of laser wire recanalization of chronic coronary artery occlusions: A single-center experience

Objectives. This study sought to elucidate the short term efficacy and intermediate term outcome of excimer laser recanalization of chronic coronary artery occlusions in patients in whom attempts at mechanical revascularization had failed. Background. Recanalization of chronic coronary occlusions with the use of a mechanical guide wire fails in 30% to 50% of cases, mostly because of inability to pass the wire through the lesion. The value of using excimer laser energy in this setting has not yet been determined. Methods. The study group comprised 66 consecutive patients with 68 chronic coronary occlusions. Patients were eligible for inclusion in the study if a previous attempt at mechanical revascularization had failed and if their angiographic status was such that 1) the vessel segment distal to the occlusion could be visualized by way of collateral vessels, 2) the entry point of the occlusion was clearly outlined, and 3) not more than one anatomic bend was expected within the occlusion. Excimer laser energy was applied to the lesion through a 0.018-in. (0.046 cm) fiber optic guide wire. Adjunctive balloon angioplasty and stenting were performed in all successfully treated patients but one. Results. Thirty-four occlusions (50%) in 32 patients (48%) could be crossed with the laser wire, Location and age of the occlusion had no adverse influence on the outcome of laser wire recanalization, nor did the presence of bridging collateral vessels, a major side branch at the site of the lesion or a blunt stump of the occlusion. An inverse relation was found between the success rate and the length of the occlusion, such that a 19% reduction of the success rate accompanied each 10 mm increment of the mean occlusion length. Thus, the success rate was 68% for lesions less than or equal to 10 mm but only 25% for lesions >30 to less than or equal to 40 mm. The presence of a bend in the lesion exceeding 60 degrees was strongly related to procedural failure, During a median angiographic follow-up period of 18 weeks, restenosis >50% (n = 6) or reocclusion (n = 4) was found in 10 of the 32 successfully treated patients, for an intermediate-term success rate of 33% (22 of 66). Clinical follow-up revealed improved anginal status in 21 patients (66%) after a median of 24 weeks. Major complications (death, myocardial infarction, emergency operation) were not encountered. Conclusions. Successful recanalization of a chronic coronary occlusion by using currently available laser wires can be expected in 50% of selected patients in whom attempts at mechanical revascularization fail. Restenosis or reocclusion accounts for an overall 6-month success rate of 35%. (C) 1997 by the American College of Cardiology.