Author + information
- Received August 19, 1993
- Revision received December 17, 1993
- Accepted December 20, 1993
- Published online May 1, 1994.
- Andreas Baumbach, MDa,∗,
- John A. Bittl, MD FACCb,
- Eckart Fleck, MDc,
- Herbert J. Geschwind, MD, FACCd,
- Timothy A. Sanborn, MD, FACCe,
- James E. Tcheng, MD, FACCf,
- Karl R.K. Arsch, MD, FACCa,
- The Coinvestigators of the U.S. and European Percutaneous Excimer Laser Coronary Angioplasty (PELCA) Registriesa
- ↵∗Address for correspondence: Dr. Andreas Baumbach, Medizinische Klinik III, Otfried-Müller-Strasse 10, 72076 Tübingen, Germany.
Objectives. The aim of this study was to document and analyze the incidence and consequences of complications of excimer laser coronary angioplasty.
Background. Excimer laser coronary angioplasty has been reported to be a safe and feasible alternative or adjunct to conventional balloon angioplasty, but serious and unique complications have been observed.
Methods. Data on 1,595 interventions of excimer laser coronary angioplasty in 1,521 patients were analyzed, using a merged data base fron the U.S. and European Percutaneous Excimer Laser Coronary Angioplasty (PELCA) registries.
Results. Procedural success was achieved in 89.3% of interventions. Stand-alone laser angioplasty was performed in 17.8% of interventions. Complications included dissection (22.0%), vasospasm (6.1%), filling defects (4.8%), abrupt reclosure (6.1%), embolization (2.3%), perforation (2.4%), arrhythmia (0.7%) and aneurysm formation (0.3%). Major complications were non-Q wave myocardial infarction (2.3%), Q wave myocardial infarction (1.0%), coronary artery bypass grafting (3.1%) and death (0.7%). Logistic regression analysis revealed correlation between dissections and the use of larger catheter size (p = 0.0005), high energy per pulse levels (p = 0.0001 for native vessels), lesion length > 10 mm (p = 0.001) and presence of a side branch (p = 0.01). The incidence of perforations was higher in women (p = 0.004), in treatment of total occlusions (p = 0.02) and in the presence of a side branch (p = 0.03). Fatal complications were correlated with patients with multivessel disease (p < 0.0001), patients with acute myocardial infarction (p = 0.0069) and older patients (> 70 years old, p = 0.004). The incidence of major complications decreased after performance of 50 laser angioplasty procedures at one institution (p = 0.02).
Conclusions. This analysis defines both the learning curve and the profile of complications for excimer laser angioplasty and provides insight into the selection of appropriate patients and proper performance of the procedure.
☆ This work was presented in part at the 65th Annual Scientific Sessions of the American Heart Association, New Orleans, Louisiana, November 1992. The European Percutaneous Excimer Laser Coronary Angioplasty (PELCA) registry was supported by grants from Medtronic Europe, Brussels, Belgium and Spectranetics, Colorado Springs, Colorado. A list of the participating centers and the principal investigators of the PELCA registries appears in the Appendix.
- Received August 19, 1993.
- Revision received December 17, 1993.
- Accepted December 20, 1993.