(Circulation. 1997;96:2183-2189.)
© 1997 American Heart Association, Inc.
Articles |
Treatment of In-Stent Restenosis With Excimer Laser Coronary Angioplasty
Mechanisms and Results Compared With PTCA Alone
From the Intravascular Ultrasound Imaging and Cardiac Catheterization Laboratories, Washington (DC) Hospital Center.
Correspondence to Martin B. Leon, MD, Director of Research, Washington Cardiology Center, 110 Irving St NW, Suite 4B1, Washington, DC 20010.
Background This study determined the clinical safety, mechanisms, and 6-month results of excimer laser angioplasty (ELCA)+adjunct PTCA for the treatment of in-stent restenosis and (via lesion matching) compared the results of ELCA+PTCA to PTCA alone.
Methods and Results Using quantitative angiography (QCA) and intravascular ultrasound (IVUS), we studied 107 restenotic previously stented lesions in 98 patients before and after intervention. QCA measurements included minimum lumen diameter (MLD) and diameter stenosis (DS). IVUS measurements included stent, lumen, and intimal hyperplasia (IH=stent-lumen) cross-sectional areas (CSA) and volumes. In the 54 lesions treated with ELCA+PTCA, the MLD increased from 0.73±0.38 mm before ELCA to 2.10±0.47 mm after ELCA+PTCA (P<.0001); the DS decreased from 70±14% to 25±12% (P<.0001). By IVUS, the minimum lumen CSA increased from 1.58±0.78 mm2 before ELCA to 6.34±1.75 mm2 after ELCA+PTCA (P<.0001) as a result of an increase in minimum stent CSA from 7.70±2.41 to 9.10±2.60 mm2 (P<.0001) and a decrease in IH CSA from 5.25±2.84 to 2.63±1.41 mm2 (P<.0001). Volumetric analysis showed that tissue ablation (during ELCA) contributed 29±15%, tissue extrusion (during adjunct PTCA) contributed 31±14%, and additional stent expansion (during adjunct PTCA) contributed 40±16% to the overall lumen gain. There were no ELCA-related complications. Matched to lesions treated with PTCA alone, ELCA+PTCA resulted in greater lumen gain, more IH ablation/extrusion, larger final lumen CSA (IVUS), and a tendency for less frequent need for subsequent target vessel revascularization (TVR, 21% versus 38%, P=.0823).
Conclusions ELCA safely and effectively ablates in-stent neointimal tissue. Adjunct PTCA extrudes neointimal tissue out of the stent and also further expands the stent. Compared with PTCA alone, ELCA+PTCA achieves better short-term and, potentially, better long-term results.
Key Words: stents • ultrasonics • lasers • angioplasty • restenosis
This article has been cited by other articles:
 |
|
 |
|
  J. Fajadet, W. Wijns, G.-J. Laarman, K.-H. Kuck, J. Ormiston, T. Munzel, J. J. Popma, P. J. Fitzgerald, R. Bonan, R. E. Kuntz, et al. Randomized, Double-Blind, Multicenter Study of the Endeavor Zotarolimus-Eluting Phosphorylcholine-Encapsulated Stent for Treatment of Native Coronary Artery Lesions: Clinical and Angiographic Results of the ENDEAVOR II Trial Circulation, August 22, 2006; 114(8): 798 - 806. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. A. Batyraliev, I. V. Pershukov, Z. A. Niyazova-Karben, A. Karaus, O. Calenici, N. Guler, B. Eryonucu, A. Temamogullari, S. Ozgul, F. Akgul, et al. Current Role of Laser Angioplasty of Restenotic Coronary Stents Angiology, January 1, 2006; 57(1): 21 - 32. [Abstract] [PDF]
|
|
|
|
 |
|
 R. Albiero, S. Silber, C. Di Mario, C. Cernigliaro, S. Battaglia, B. Reimers, A. Frasheri, V. Klauss, J. M. Auge, P. Rubartelli, et al. Cutting balloon versus conventional balloon angioplasty for the treatment of in-stent restenosis: Results of the restenosis cutting balloon evaluation trial (RESCUT) J. Am. Coll. Cardiol., March 17, 2004; 43(6): 943 - 949. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. Waksman, A. E. Ajani, R. L. White, R. Chan, B. Bass, A. D. Pichard, L. F. Satler, K. M. Kent, R. Torguson, R. Deible, et al. Five-Year Follow-Up After Intracoronary Gamma Radiation Therapy for In-Stent Restenosis Circulation, January 27, 2004; 109(3): 340 - 344. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. Urban, P. Serruys, D. Baumgart, A. Colombo, S. Silber, E. Eeckhout, A. Gershlick, K. Wegscheider, L. Verhees, R. Bonan, et al. A multicentre European registry of intraluminal coronary beta brachytherapy Eur. Heart J., April 1, 2003; 24(7): 604 - 612. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. E. Ajani, R. Waksman, E. Cheneau, D.-H. Cha, S. McGlynn, M. Castagna, R. C. Chan, L. F. Satler, K. M. Kent, A. D. Pichard, et al. The outcome of percutaneous coronary intervention in patients with In-Stentrestenosis who failed intracoronary radiation therapy J. Am. Coll. Cardiol., February 19, 2003; 41(4): 551 - 556. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P.W Radke, A Kaiser, C Frost, and U Sigwart Outcome after treatment of coronary in-stent restenosis: Results from a systematic review using meta-analysis techniques Eur. Heart J., February 1, 2003; 24(3): 266 - 273. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
V. Spanos, G. Stankovic, J. Tobis, and A. Colombo The challenge of in-stent restenosis: insights from intravascular ultrasound Eur. Heart J., January 2, 2003; 24(2): 138 - 150. [Full Text] [PDF]
|
|
|
|
|
|
J. J. Popma, M. Suntharalingam, A. J. Lansky, R. R. Heuser, B. Speiser, P. S. Teirstein, V. Massullo, T. Bass, R. Henderson, S. Silber, et al. Randomized Trial of 90Sr/90Y {beta}-Radiation Versus Placebo Control for Treatment of In-Stent Restenosis Circulation, August 27, 2002; 106(9): 1090 - 1096. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. Waksman, A. E. Ajani, R. L. White, R. C. Chan, L. F. Satler, K. M. Kent, A. D. Pichard, E. E. Pinnow, A. B. Bui, S. Ramee, et al. Intravascular Gamma Radiation for In-Stent Restenosis in Saphenous-Vein Bypass Grafts N. Engl. J. Med., April 18, 2002; 346(16): 1194 - 1199. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. M. Ahmed, G. S. Mintz, R. Waksman, R. Mehran, B. Leiboff, A. D. Pichard, L. F. Satler, K. M. Kent, and N. J. Weissman Serial Intravascular Ultrasound Assessment of the Efficacy of Intracoronary {gamma}-Radiation Therapy for Preventing Recurrence in Very Long, Diffuse, In-Stent Restenosis Lesions Circulation, August 21, 2001; 104(8): 856 - 859. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Moustapha, A. R. Assali, S. Sdringola, W. K. Vaughn, R. D. Fish, O. Rosales, G. Schroth, Z. Krajcer, R. W. Smalling, and H. V. Anderson Percutaneous and surgical interventions for in-stent restenosis: long-term outcomes and effect of diabetes mellitus J. Am. Coll. Cardiol., June 1, 2001; 37(7): 1877 - 1882. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. M. Ahmed, G. S. Mintz, R. Waksman, N. J. Weissman, B. Leiboff, A. D. Pichard, L. F. Satler, K. M. Kent, and M. B. Leon Serial Intravascular Ultrasound Analysis of the Impact of Lesion Length on the Efficacy of Intracoronary {{gamma}}-Irradiation for Preventing Recurrent In-Stent Restenosis Circulation, January 16, 2001; 103(2): 188 - 191. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. Hoffmann and G.S. Mintz Coronary in-stent restenosis--predictors, treatment and prevention Eur. Heart J., November 1, 2000; 21(21): 1739 - 1749. [PDF]
|
|
|
|
|
|
F. Alfonso, C. Hernandez, M. J. Perez-Vizcayno, R. Hernandez, A. Fernandez-Ortiz, J. Escaned, C. Banuelos, M. Sabate, M. Sanmartin, C. Fernandez, et al. Fate of stent-related side branches after coronary intervention in patients with in-stent restenosis J. Am. Coll. Cardiol., November 1, 2000; 36(5): 1549 - 1556. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C Di Mario, F Marsico, M Adamian, E Karvouni, R Albiero, and A Colombo New recipes for in-stent restenosis: cut, grate, roast, or sandwich the neointima? Heart, November 1, 2000; 84(5): 471 - 475. [Full Text]
|
|
|
|
 |
|
 J. Al Suwaidi, P. B. Berger, and D. R. Holmes Jr Coronary Artery Stents JAMA, October 11, 2000; 284(14): 1828 - 1836. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C M Gross, J Kramer, O Weingartner, F Uhlich, R Dietz, and J Waigand Clinical and angiographic outcome in patients with in-stent restenosis and repeat target lesion revascularisation in small coronary arteries Heart, September 1, 2000; 84(3): 307 - 313. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Lafont, J. L. Dubois-Rande, P. G. Steg, P. Dupouy, D. Carrie, P. Coste, A. Furber, F. Beygui, L. J. Feldman, S. Rahal, et al. The French randomized optimal stenting trial: a prospective evaluation of provisional stenting guided by coronary velocity reserve and quantitative coronary angiography J. Am. Coll. Cardiol., August 1, 2000; 36(2): 404 - 409. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. Koster, J. Kahler, W. Terres, J. Reimers, S. Baldus, D. Hartig, J.u. Berger, T. Meinertz, and C. W. Hamm Six-month clinical and angiographic outcome after successful excimer laser angioplasty for in-stent restenosis J. Am. Coll. Cardiol., July 1, 2000; 36(1): 69 - 74. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. Mehran, G. Dangas, G. S. Mintz, R. Waksman, A. Abizaid, L. F. Satler, A. D. Pichard, K. M. Kent, A. J. Lansky, G. W. Stone, et al. Treatment of In-Stent Restenosis With Excimer Laser Coronary Angioplasty Versus Rotational Atherectomy : Comparative Mechanisms and Results Circulation, May 30, 2000; 101(21): 2484 - 2489. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. Waksman, R. L. White, R. C. Chan, B. G. Bass, L. Geirlach, G. S. Mintz, L. F. Satler, R. Mehran, P. W. Serruys, A. J. Lansky, et al. Intracoronary {gamma}-Radiation Therapy After Angioplasty Inhibits Recurrence in Patients With In-Stent Restenosis Circulation, May 9, 2000; 101(18): 2165 - 2171. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F Schiele, N Meneveau, M.-F Seronde, M.-F Deforet, S Gupta, and J.-P Bassand Predictors of event-free survival after repeat intracoronary procedure for in-stent restenosis. Study with angiographic and intravascular ultrasound imaging Eur. Heart J., May 1, 2000; 21(9): 754 - 762. [Abstract] [PDF]
|
|
|
|
|
|
I. Bossi, C. Klersy, A. J. Black, R. Cortina, R. Choussat, B. Cassagneau, C. Jordan, J.-C. Laborde, J.-P. Laurent, M. Bernies, et al. In-stent restenosis: long-term outcome and predictors of subsequent target lesion revascularization after repeat balloon angioplasty J. Am. Coll. Cardiol., May 1, 2000; 35(6): 1569 - 1576. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. P. Carrozza Jr. In-stent restenosis: should an old device treat a new problem? J. Am. Coll. Cardiol., May 1, 2000; 35(6): 1577 - 1579. [Full Text] [PDF]
|
|
|
|
|
|
R. Waksman, B. Bhargava, L. White, R. C. Chan, R. Mehran, A. J. Lansky, G. S. Mintz, L. F. Satler, A. D. Pichard, M. B. Leon, et al. Intracoronary {beta}-Radiation Therapy Inhibits Recurrence of In-Stent Restenosis Circulation, April 25, 2000; 101(16): 1895 - 1898. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. Mehran, G. Dangas, A. S. Abizaid, G. S. Mintz, A. J. Lansky, L. F. Satler, A. D. Pichard, K. M. Kent, G. W. Stone, and M. B. Leon Angiographic Patterns of In-Stent Restenosis : Classification and Implications for Long-Term Outcome Circulation, November 2, 1999; 100(18): 1872 - 1878. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. Koster, C. W. Hamm, R. Seabra-Gomes, G. Herrmann, H. Sievert, C. Macaya, E. Fleck, K. Fischer, J. J. R. M. Bonnier, J. Fajadet, et al. Laser angioplasty of restenosed coronary stents: results of a multicenter surveillance trial J. Am. Coll. Cardiol., July 1, 1999; 34(1): 25 - 32. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. W. Radke, H. G. Klues, P. K. Haager, R. Hoffmann, F. Kastrau, T. Reffelmann, U. Janssens, J. vom Dahl, and P. Hanrath Mechanisms of acute lumen gain and recurrent restenosis after rotational atherectomy of diffuse in-stent restenosis: A quantitative angiographic and intravascular ultrasound study J. Am. Coll. Cardiol., July 1, 1999; 34(1): 33 - 39. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. K. Sharma, S. Duvvuri, G. Dangas, A. Kini, R. Vidhun, K. Venu, J. A. Ambrose, and J. D. Marmur Rotational atherectomy for in-stent restenosis: acute and long-term results of the first 100 cases J. Am. Coll. Cardiol., November 1, 1998; 32(5): 1358 - 1365. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H.e. Eltchaninoff, R. Koning, C. Tron, V. Gupta, and A. Cribier Balloon angioplasty for the treatment of coronary in-stent restenosis: immediate results and 6-month angiographic recurrent restenosis rate J. Am. Coll. Cardiol., October 1, 1998; 32(4): 980 - 984. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Shiran, G. S. Mintz, R. Waksman, R. Mehran, A. Abizaid, K. M. Kent, A. D. Pichard, L. F. Satler, J. J. Popma, and M. B. Leon Early Lumen Loss After Treatment of In-Stent Restenosis : An Intravascular Ultrasound Study Circulation, July 21, 1998; 98(3): 200 - 203. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. Bauters, J.-L. Banos, E. Van Belle, E. P. Mc Fadden, J.-M. Lablanche, and M. E. Bertrand Six-Month Angiographic Outcome After Successful Repeat Percutaneous Intervention for In-Stent Restenosis Circulation, February 3, 1998; 97(4): 318 - 321. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. Liistro, G. Stankovic, C. Di Mario, T. Takagi, A. Chieffo, S. Moshiri, M. Montorfano, M. Carlino, C. Briguori, P. Pagnotta, et al. First Clinical Experience With a Paclitaxel Derivate-Eluting Polymer Stent System Implantation for In-Stent Restenosis: Immediate and Long-Term Clinical and Angiographic Outcome Circulation, April 23, 2002; 105(16): 1883 - 1886. [Abstract] [Full Text] [PDF]
|
|