Laser coronary angioplasty: history, present and future
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Laser coronary angioplasty: history, present and future. / Köster, Ralf; Kähler, Jan; Brockhoff, Carsten; Münzel, Thomas; Meinertz, Thomas.
In: AM J CARDIOVASC DRUG, Vol. 2, No. 3, 2002, p. 197-207.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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T1 - Laser coronary angioplasty: history, present and future
AU - Köster, Ralf
AU - Kähler, Jan
AU - Brockhoff, Carsten
AU - Münzel, Thomas
AU - Meinertz, Thomas
PY - 2002
Y1 - 2002
N2 - The efficacy of percutaneous transluminal coronary angioplasty (PTCA) is limited by remaining plaque tissue and the development of restenosis. It has been demonstrated that the restenosis rate is low if a large lumen diameter is achieved after coronary intervention. Debulking of coronary stenoses is a concept to increase the luminal diameter after intervention. Laser angioplasty debulks coronary stenoses by ablation of atherosclerotic plaque. Since the first intravascular laser intervention, the technique has been significantly improved by the use of optimized wavelength, the development of flexible optimally spaced multifiber catheters and an additional saline flush technique. These technical advancements allowed a reduction in the incidence of adverse events, such as the number of dissections and perforations, associated with the use of the laser technique. Coronary laser angioplasty is commonly combined with adjunctive balloon angioplasty to optimize the outcome. Laser coronary angioplasty was not followed by a lower restenosis rate compared with plain balloon angioplasty in lesions without stents, however, a randomized comparison of the techniques including the use of the saline flush technique is not available yet. The value of excimer (acronym for excited dimer) laser coronary angioplasty for treatment of in-stent restenosis is still under investigation. So far, nonrandomized single center studies have not suggested a relevant benefit for this technique used for in-stent restenosis. In nonstented lesions there remain niche indications for laser angioplasty such as the treatment of ostial lesions, diffuse lesions or lesions traversable with a guidewire but not with an angioplasty balloon. Laser coronary angioplasty may also be useful after a failed balloon angioplasty and in patients with chronic total occlusions. The potential advantages of combining laser coronary angioplasty with vaporization of thrombus in patients with acute coronary syndromes are currently under evaluation.
AB - The efficacy of percutaneous transluminal coronary angioplasty (PTCA) is limited by remaining plaque tissue and the development of restenosis. It has been demonstrated that the restenosis rate is low if a large lumen diameter is achieved after coronary intervention. Debulking of coronary stenoses is a concept to increase the luminal diameter after intervention. Laser angioplasty debulks coronary stenoses by ablation of atherosclerotic plaque. Since the first intravascular laser intervention, the technique has been significantly improved by the use of optimized wavelength, the development of flexible optimally spaced multifiber catheters and an additional saline flush technique. These technical advancements allowed a reduction in the incidence of adverse events, such as the number of dissections and perforations, associated with the use of the laser technique. Coronary laser angioplasty is commonly combined with adjunctive balloon angioplasty to optimize the outcome. Laser coronary angioplasty was not followed by a lower restenosis rate compared with plain balloon angioplasty in lesions without stents, however, a randomized comparison of the techniques including the use of the saline flush technique is not available yet. The value of excimer (acronym for excited dimer) laser coronary angioplasty for treatment of in-stent restenosis is still under investigation. So far, nonrandomized single center studies have not suggested a relevant benefit for this technique used for in-stent restenosis. In nonstented lesions there remain niche indications for laser angioplasty such as the treatment of ostial lesions, diffuse lesions or lesions traversable with a guidewire but not with an angioplasty balloon. Laser coronary angioplasty may also be useful after a failed balloon angioplasty and in patients with chronic total occlusions. The potential advantages of combining laser coronary angioplasty with vaporization of thrombus in patients with acute coronary syndromes are currently under evaluation.
KW - Angioplasty, Laser/history
KW - Coronary Disease/surgery
KW - History, 20th Century
KW - History, 21st Century
KW - Humans
KW - Randomized Controlled Trials as Topic
U2 - 10.2165/00129784-200202030-00006
DO - 10.2165/00129784-200202030-00006
M3 - SCORING: Journal article
C2 - 14727981
VL - 2
SP - 197
EP - 207
JO - AM J CARDIOVASC DRUG
JF - AM J CARDIOVASC DRUG
SN - 1175-3277
IS - 3
ER -