Circulation, Vol 86, 820-827, Copyright © 1992 by American Heart Association
ZM Ghazzal, JA Hearn, F Litvack, T Goldenberg, KM Kent, N Eigler, JS Douglas Jr and SB King 3d
BACKGROUND. Percutaneous excimer laser coronary angioplasty (ELCA) is a new
technique for recanalization of arteries obstructed by coronary
atherosclerosis. This study was conducted to assess the complication rate
and determine the influence of clinical and angiographic characteristics on
complications after ELCA. METHODS AND RESULTS. A detailed, quantitative,
angiographic core laboratory analysis of patients undergoing ELCA was
performed by two experienced angiographers who were not the primary laser
angioplasty operators. Two hundred patients underwent 203 separate
procedures on 220 lesions at three medical centers. Laser success was
achieved in 180 lesions (81.8%) and procedural success in 199 (90.5%).
Emergency coronary artery bypass graft (CABG) was required in five patients
(2.5%). One patient suffered a Q wave myocardial infarction; there were no
deaths. Also, acute closure and perforation occurred in 10 (4.5%) and three
(1.4%) vessels, respectively. Coronary dissections after laser treatment
were seen in 36 vessels (16.4%). Multivariate analysis found two
independent preprocedural factors related to complications: eccentricity
index, which is the percent deviation of the lesion lumen from the center
of the artery (p = 0.0007), and proximal vessel diameter (p = 0.033). In
addition, an abrupt proximal face of the lesion was associated with
angiographic complications by univariate analysis (p = 0.051). Multivariate
analysis showed the eccentricity index (p = 0.032) to be the only
independent predictor for the occurrence of any one or more of the
important complications (emergency CABG, perforation, acute closure, or Q
wave myocardial infarction), whereas lesion angle greater than 45 degrees
was a significant univariate predictor (p = 0.029). Other predictors of
complications with balloon percutaneous transluminal coronary angioplasty,
such as increased lesion length, rough edges, calcification, ulceration,
and branch point, were not predictive of complications with the excimer
laser. CONCLUSIONS. The degree of lesion eccentricity is the most powerful
predictor of complications after ELCA. This and other morphological
predictors may be of benefit in the selection of patients for ELCA as well
as directing future development of this new technology.
ARTICLES
Morphological predictors of acute complications after percutaneous excimer laser coronary angioplasty. Results of a comprehensive angiographic analysis: importance of the eccentricity index
Division of Cardiology, Andreas Gruentzig Cardiovascular Center, Emory University School of Medicine, Atlanta, Ga.
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