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Acute complications of excimer laser coronary angioplasty: a detailed analysis of multicenter results. Coinvestigators of the U.S. and European Percutaneous Excimer Laser Coronary Angioplasty (PELCA) Registries.

Publication ,  Journal Article
Baumbach, A; Bittl, JA; Fleck, E; Geschwind, HJ; Sanborn, TA; Tcheng, JE; Karsch, KR
Published in: J Am Coll Cardiol
May 1994

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 from 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 = 0.0009) 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.

Duke Scholars

Published In

J Am Coll Cardiol

DOI

ISSN

0735-1097

Publication Date

May 1994

Volume

23

Issue

6

Start / End Page

1305 / 1313

Location

United States

Related Subject Headings

  • United States
  • Registries
  • Postoperative Complications
  • Multivariate Analysis
  • Middle Aged
  • Male
  • Logistic Models
  • Incidence
  • Humans
  • Female
 

Citation

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ICMJE
MLA
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Baumbach, A., Bittl, J. A., Fleck, E., Geschwind, H. J., Sanborn, T. A., Tcheng, J. E., & Karsch, K. R. (1994). Acute complications of excimer laser coronary angioplasty: a detailed analysis of multicenter results. Coinvestigators of the U.S. and European Percutaneous Excimer Laser Coronary Angioplasty (PELCA) Registries. J Am Coll Cardiol, 23(6), 1305–1313. https://doi.org/10.1016/0735-1097(94)90371-9
Baumbach, A., J. A. Bittl, E. Fleck, H. J. Geschwind, T. A. Sanborn, J. E. Tcheng, and K. R. Karsch. “Acute complications of excimer laser coronary angioplasty: a detailed analysis of multicenter results. Coinvestigators of the U.S. and European Percutaneous Excimer Laser Coronary Angioplasty (PELCA) Registries.J Am Coll Cardiol 23, no. 6 (May 1994): 1305–13. https://doi.org/10.1016/0735-1097(94)90371-9.
Journal cover image

Published In

J Am Coll Cardiol

DOI

ISSN

0735-1097

Publication Date

May 1994

Volume

23

Issue

6

Start / End Page

1305 / 1313

Location

United States

Related Subject Headings

  • United States
  • Registries
  • Postoperative Complications
  • Multivariate Analysis
  • Middle Aged
  • Male
  • Logistic Models
  • Incidence
  • Humans
  • Female