Immediate and late outcome of excimer laser and balloon coronary angioplasty: A quantitative angiographic comparison based on matched lesions

Objectives.This study sought to compare acute lumen changes and late lumen narrowing during and after excimer laser-assisted balloon angioplasty, measured by quantitative coronary angiography, with the immediate and long-term outcome of balloon angioplasty alone.Background.Although excimer laser coronary angioplasty is used as an adjunct or alternative to balloon angioplasty, limited comparative data exist regarding the immediate and long-term efficacy of excimer laser-assisted balloon angioplasty versus balloon angioplasty alone.Methods.A series of 53 lesions in 47 consecutive patients successfully treated with excimer laser-assisted balloon angioplasty were individually matched after completion of 6-month follow-up angiography with 53 successfully treated balloon angioplasty lesions according to vessel location, preprocedural minimal lumen diameter and reference diameter. Immediate and long-term angiographic results were assessed by an automated lumen contour detection algorithm.Results.Before intervention in the laser and balloon angioplasty groups, respectively, minimal lumen diameter (mean ± SD) was 0.73 ± 0.47 and 0.74 ± 0.46 mm, and reference diameter was 2.71 ± 0.42 and 2.72 ± 0.41 mm. Laser angioplasty was followed by adjunctive balloon dilation in 50 lesions. Mean balloon diameter at maximal inflation was similar in both treatment groups (2.61 ± 0.32 and 2.65 ± 0.38 mm, respectively), resulting in similar minimal lumen diameters after intervention of 1.77 ± 0.41 and 1.78 ± 0.34 mm, respectively. At follow-up angiography, minimal lumen diameter after excimer laser-assisted balloon angioplasty was 1.17 ± 0.63 mm, and that after balloon angioplasty alone was 1.46 ± 0.67 mm (p = 0.02). The angiographic restenosis rates at follow-up using the 50% diameter stenosis cutoff criterion were 57% and 34%, respectively (p = 0.02).Conclusions.Quantitative angiographic analysis of a matched group of 106 successfully treated coronary lesions showed a similar immediate outcome but reduced long-term efficacy of excimer laser-assisted balloon angioplasty compared with that after balloon angioplasty alone