Laser angioplasty of restenosed coronary stents

Results of a multicenter surveillance trial

Ralf Köster, Christian W. Hamm, Ricardo Seabra-Gomes, Gunhild Herrmann, Horst Sievert, Carlos Macaya, Eckart Fleck, Klaus Fischer, Johannes J R M Bonnier, Jean Fajadet, J. ürgen Waigand, Karl Heinz Kuck, Michel Henry, Marie Claude Morice, Luciano Pizzulli, Michael M. Webb-Peploe, Arnd B. Buchwald, Lars Ekström, Eberhard Grube, Saad Al Kasab & 11 others Antonio Colombo, Archimedes Sanati, Sjef M P G Ernst, Michael Haude, Martin B. Leon, Charles Ilsley, Rafael Beyar, Yvo Taeymans, Uwe Gladbach, Karl Wegscheider, Patrick W. Serruys

Research output: Contribution to journalArticle

50 Citations (Scopus)

Abstract

OBJECTIVES: This study evaluated safety and efficacy of excimer laser angioplasty for treatment of restenosed or occluded coronary stents. BACKGROUND: Balloon angioplasty of in-stent restenosis is limited by a high recurrence rate. Debulking by laser angioplasty is a novel concept to treat in-stent restenosis. METHODS: A total of 440 patients with restenoses or occlusions in 527 stents were enrolled for treatment with concentric or eccentric laser catheters and adjunctive balloon angioplasty. RESULTS: Laser angioplasty success (≤50% diameter stenosis after laser treatment or successful passage with a 2.0-mm or 1.7-mm eccentric laser catheter) was achieved in 92% of patients. Adjunctive balloon angioplasty was performed in 99%. Procedural success (laser angioplasty success followed by ≤30% stenosis with or without balloon angioplasty) was 91%. There was neither a significant difference in success with respect to lesion length, nor were there differences between small and large vessels or native vessels and vein grafts. Success was higher and residual stenosis lower using large or eccentric catheters. Serious adverse events included death (1.6%, not directly laser catheter related), Q-wave myocardial infarction (0.5%), non-Q- wave infarction (2.7%), cardiac tamponade (0.5%) and stent damage (0.5%) . Perforations after laser treatment occurred in 0.9% of patients and after balloon angioplasty in 0.2%. Dissections were visible in 4.8% of patients after laser treatment and in 9.3% after balloon angioplasty. Reinterventions during hospitalization were necessary in 0.9% of patients; bypass surgery was performed in 0.2%. CONCLUSIONS: Excimer laser angioplasty with adjunctive balloon angioplasty is a safe and efficient technology to treat in-stent restenoses. These data justify a randomized comparison with balloon angioplasty.

Original languageEnglish
Pages (from-to)25-32
Number of pages8
JournalJournal of the American College of Cardiology
Volume34
Issue number1
DOIs
Publication statusPublished - Jul 1999

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Laser Angioplasty
Balloon Angioplasty
Multicenter Studies
Stents
Lasers
Catheters
Excimer Lasers
Pathologic Constriction
Therapeutics
Cardiac Tamponade
Infarction
Dissection
Veins
Hospitalization
Myocardial Infarction
Technology
Transplants
Safety
Recurrence

ASJC Scopus subject areas

  • Nursing(all)

Cite this

Köster, R., Hamm, C. W., Seabra-Gomes, R., Herrmann, G., Sievert, H., Macaya, C., ... Serruys, P. W. (1999). Laser angioplasty of restenosed coronary stents: Results of a multicenter surveillance trial. Journal of the American College of Cardiology, 34(1), 25-32. https://doi.org/10.1016/S0735-1097(99)00167-9

Laser angioplasty of restenosed coronary stents : Results of a multicenter surveillance trial. / Köster, Ralf; Hamm, Christian W.; Seabra-Gomes, Ricardo; Herrmann, Gunhild; Sievert, Horst; Macaya, Carlos; Fleck, Eckart; Fischer, Klaus; Bonnier, Johannes J R M; Fajadet, Jean; Waigand, J. ürgen; Kuck, Karl Heinz; Henry, Michel; Morice, Marie Claude; Pizzulli, Luciano; Webb-Peploe, Michael M.; Buchwald, Arnd B.; Ekström, Lars; Grube, Eberhard; Al Kasab, Saad; Colombo, Antonio; Sanati, Archimedes; Ernst, Sjef M P G; Haude, Michael; Leon, Martin B.; Ilsley, Charles; Beyar, Rafael; Taeymans, Yvo; Gladbach, Uwe; Wegscheider, Karl; Serruys, Patrick W.

In: Journal of the American College of Cardiology, Vol. 34, No. 1, 07.1999, p. 25-32.

Research output: Contribution to journalArticle

Köster, R, Hamm, CW, Seabra-Gomes, R, Herrmann, G, Sievert, H, Macaya, C, Fleck, E, Fischer, K, Bonnier, JJRM, Fajadet, J, Waigand, JÜ, Kuck, KH, Henry, M, Morice, MC, Pizzulli, L, Webb-Peploe, MM, Buchwald, AB, Ekström, L, Grube, E, Al Kasab, S, Colombo, A, Sanati, A, Ernst, SMPG, Haude, M, Leon, MB, Ilsley, C, Beyar, R, Taeymans, Y, Gladbach, U, Wegscheider, K & Serruys, PW 1999, 'Laser angioplasty of restenosed coronary stents: Results of a multicenter surveillance trial', Journal of the American College of Cardiology, vol. 34, no. 1, pp. 25-32. https://doi.org/10.1016/S0735-1097(99)00167-9
Köster, Ralf ; Hamm, Christian W. ; Seabra-Gomes, Ricardo ; Herrmann, Gunhild ; Sievert, Horst ; Macaya, Carlos ; Fleck, Eckart ; Fischer, Klaus ; Bonnier, Johannes J R M ; Fajadet, Jean ; Waigand, J. ürgen ; Kuck, Karl Heinz ; Henry, Michel ; Morice, Marie Claude ; Pizzulli, Luciano ; Webb-Peploe, Michael M. ; Buchwald, Arnd B. ; Ekström, Lars ; Grube, Eberhard ; Al Kasab, Saad ; Colombo, Antonio ; Sanati, Archimedes ; Ernst, Sjef M P G ; Haude, Michael ; Leon, Martin B. ; Ilsley, Charles ; Beyar, Rafael ; Taeymans, Yvo ; Gladbach, Uwe ; Wegscheider, Karl ; Serruys, Patrick W. / Laser angioplasty of restenosed coronary stents : Results of a multicenter surveillance trial. In: Journal of the American College of Cardiology. 1999 ; Vol. 34, No. 1. pp. 25-32.
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abstract = "OBJECTIVES: This study evaluated safety and efficacy of excimer laser angioplasty for treatment of restenosed or occluded coronary stents. BACKGROUND: Balloon angioplasty of in-stent restenosis is limited by a high recurrence rate. Debulking by laser angioplasty is a novel concept to treat in-stent restenosis. METHODS: A total of 440 patients with restenoses or occlusions in 527 stents were enrolled for treatment with concentric or eccentric laser catheters and adjunctive balloon angioplasty. RESULTS: Laser angioplasty success (≤50{\%} diameter stenosis after laser treatment or successful passage with a 2.0-mm or 1.7-mm eccentric laser catheter) was achieved in 92{\%} of patients. Adjunctive balloon angioplasty was performed in 99{\%}. Procedural success (laser angioplasty success followed by ≤30{\%} stenosis with or without balloon angioplasty) was 91{\%}. There was neither a significant difference in success with respect to lesion length, nor were there differences between small and large vessels or native vessels and vein grafts. Success was higher and residual stenosis lower using large or eccentric catheters. Serious adverse events included death (1.6{\%}, not directly laser catheter related), Q-wave myocardial infarction (0.5{\%}), non-Q- wave infarction (2.7{\%}), cardiac tamponade (0.5{\%}) and stent damage (0.5{\%}) . Perforations after laser treatment occurred in 0.9{\%} of patients and after balloon angioplasty in 0.2{\%}. Dissections were visible in 4.8{\%} of patients after laser treatment and in 9.3{\%} after balloon angioplasty. Reinterventions during hospitalization were necessary in 0.9{\%} of patients; bypass surgery was performed in 0.2{\%}. CONCLUSIONS: Excimer laser angioplasty with adjunctive balloon angioplasty is a safe and efficient technology to treat in-stent restenoses. These data justify a randomized comparison with balloon angioplasty.",
author = "Ralf K{\"o}ster and Hamm, {Christian W.} and Ricardo Seabra-Gomes and Gunhild Herrmann and Horst Sievert and Carlos Macaya and Eckart Fleck and Klaus Fischer and Bonnier, {Johannes J R M} and Jean Fajadet and Waigand, {J. {\"u}rgen} and Kuck, {Karl Heinz} and Michel Henry and Morice, {Marie Claude} and Luciano Pizzulli and Webb-Peploe, {Michael M.} and Buchwald, {Arnd B.} and Lars Ekstr{\"o}m and Eberhard Grube and {Al Kasab}, Saad and Antonio Colombo and Archimedes Sanati and Ernst, {Sjef M P G} and Michael Haude and Leon, {Martin B.} and Charles Ilsley and Rafael Beyar and Yvo Taeymans and Uwe Gladbach and Karl Wegscheider and Serruys, {Patrick W.}",
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T1 - Laser angioplasty of restenosed coronary stents

T2 - Results of a multicenter surveillance trial

AU - Köster, Ralf

AU - Hamm, Christian W.

AU - Seabra-Gomes, Ricardo

AU - Herrmann, Gunhild

AU - Sievert, Horst

AU - Macaya, Carlos

AU - Fleck, Eckart

AU - Fischer, Klaus

AU - Bonnier, Johannes J R M

AU - Fajadet, Jean

AU - Waigand, J. ürgen

AU - Kuck, Karl Heinz

AU - Henry, Michel

AU - Morice, Marie Claude

AU - Pizzulli, Luciano

AU - Webb-Peploe, Michael M.

AU - Buchwald, Arnd B.

AU - Ekström, Lars

AU - Grube, Eberhard

AU - Al Kasab, Saad

AU - Colombo, Antonio

AU - Sanati, Archimedes

AU - Ernst, Sjef M P G

AU - Haude, Michael

AU - Leon, Martin B.

AU - Ilsley, Charles

AU - Beyar, Rafael

AU - Taeymans, Yvo

AU - Gladbach, Uwe

AU - Wegscheider, Karl

AU - Serruys, Patrick W.

PY - 1999/7

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N2 - OBJECTIVES: This study evaluated safety and efficacy of excimer laser angioplasty for treatment of restenosed or occluded coronary stents. BACKGROUND: Balloon angioplasty of in-stent restenosis is limited by a high recurrence rate. Debulking by laser angioplasty is a novel concept to treat in-stent restenosis. METHODS: A total of 440 patients with restenoses or occlusions in 527 stents were enrolled for treatment with concentric or eccentric laser catheters and adjunctive balloon angioplasty. RESULTS: Laser angioplasty success (≤50% diameter stenosis after laser treatment or successful passage with a 2.0-mm or 1.7-mm eccentric laser catheter) was achieved in 92% of patients. Adjunctive balloon angioplasty was performed in 99%. Procedural success (laser angioplasty success followed by ≤30% stenosis with or without balloon angioplasty) was 91%. There was neither a significant difference in success with respect to lesion length, nor were there differences between small and large vessels or native vessels and vein grafts. Success was higher and residual stenosis lower using large or eccentric catheters. Serious adverse events included death (1.6%, not directly laser catheter related), Q-wave myocardial infarction (0.5%), non-Q- wave infarction (2.7%), cardiac tamponade (0.5%) and stent damage (0.5%) . Perforations after laser treatment occurred in 0.9% of patients and after balloon angioplasty in 0.2%. Dissections were visible in 4.8% of patients after laser treatment and in 9.3% after balloon angioplasty. Reinterventions during hospitalization were necessary in 0.9% of patients; bypass surgery was performed in 0.2%. CONCLUSIONS: Excimer laser angioplasty with adjunctive balloon angioplasty is a safe and efficient technology to treat in-stent restenoses. These data justify a randomized comparison with balloon angioplasty.

AB - OBJECTIVES: This study evaluated safety and efficacy of excimer laser angioplasty for treatment of restenosed or occluded coronary stents. BACKGROUND: Balloon angioplasty of in-stent restenosis is limited by a high recurrence rate. Debulking by laser angioplasty is a novel concept to treat in-stent restenosis. METHODS: A total of 440 patients with restenoses or occlusions in 527 stents were enrolled for treatment with concentric or eccentric laser catheters and adjunctive balloon angioplasty. RESULTS: Laser angioplasty success (≤50% diameter stenosis after laser treatment or successful passage with a 2.0-mm or 1.7-mm eccentric laser catheter) was achieved in 92% of patients. Adjunctive balloon angioplasty was performed in 99%. Procedural success (laser angioplasty success followed by ≤30% stenosis with or without balloon angioplasty) was 91%. There was neither a significant difference in success with respect to lesion length, nor were there differences between small and large vessels or native vessels and vein grafts. Success was higher and residual stenosis lower using large or eccentric catheters. Serious adverse events included death (1.6%, not directly laser catheter related), Q-wave myocardial infarction (0.5%), non-Q- wave infarction (2.7%), cardiac tamponade (0.5%) and stent damage (0.5%) . Perforations after laser treatment occurred in 0.9% of patients and after balloon angioplasty in 0.2%. Dissections were visible in 4.8% of patients after laser treatment and in 9.3% after balloon angioplasty. Reinterventions during hospitalization were necessary in 0.9% of patients; bypass surgery was performed in 0.2%. CONCLUSIONS: Excimer laser angioplasty with adjunctive balloon angioplasty is a safe and efficient technology to treat in-stent restenoses. These data justify a randomized comparison with balloon angioplasty.

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