Author + information
- Received June 5, 1997
- Revision received August 27, 1997
- Accepted September 2, 1997
- Published online December 1, 1997.
- Gregg W. Stone, MD, FACCA,* (, )
- Eduardo de Marchena, MD, FACCB,
- David Dageforde, MD, FACCC,
- Alberto Foschi, MD, FACCD,
- Joseph B. Muhlestein, MD, FACCE,
- Michael McIvor, MD, FACCF,
- David Rizik, MD, FACCG,
- Ronald Vanderlaan, MD, FACCH,
- JoAnn McDonnell, RN, MAA,1,
- for the Laser Angioplasty Versus Angioplasty (LAVA) Trial Investigators
- ↵*Dr. Gregg W. Stone, The Cardiovascular Institute, 2660 Grant Road, Mountain View, California 94040.
Objectives. The goal of this study was to examine the relative safety and efficacy of laser-facilitated percutaneous transluminal coronary angioplasty (PTCA) versus “stand-alone” PTCA.
Background. Plaque debulking with lasing before PTCA may result in improved lumen dimensions and decreased rates of periprocedural ischemic complications, thus improving short- and long-term outcomes after percutaneous intervention. The mid-infrared holmium:yttrium-aluminum-garnet (YAG) laser has been shown to be effective in a variety of plaque subtypes and may be particularly useful in high risk acute ischemic syndromes.
Methods. A total of 215 patients (mean [±SD] age 61 ± 12 years) with 244 lesions were prospectively randomized at 14 clinical centers to laser versus stand-alone PTCA. After laser treatment, all patients underwent PTCA; 148 patients (69%) had unstable angina.
Results. The procedural success rate without major catheterization laboratory complications was similar in patients assigned to laser treatment or PTCA alone (96.6% vs. 96.9%, p = 0.88), as was the in-hospital clinical success rate (89.7% vs. 93.9%, p = 0.27). There was no difference in postprocedural diameter stenosis after laser treatment compared with PTCA (18.3% ± 13.6% vs. 19.5% ± 15.1%, p = 0.50). However, use of the laser, versus PTCA alone, did result in significantly more major and minor procedural complications (18.0% vs. 3.1%, p = 0.0004), myocardial infarctions (4.3% vs. 0%, p = 0.04) and total in-hospital major adverse events (10.3% vs. 4.1%, p = 0.08). At a mean follow-up time of 11.2 ± 7.7 months, there were no differences in late or event-free survival in patients assigned to laser treatment versus PTCA alone.
Conclusions. Compared with stand-alone PTCA, laser-facilitated PTCA results in a more complicated hospital course, without immediate or long-term benefits.
- Received June 5, 1997.
- Revision received August 27, 1997.
- Accepted September 2, 1997.
- The American College of Cardiology