Case-control registry of excimer laser coronary angioplasty versus distal protection devices in patients with acute coronary syndromes due to saphenous vein graft disease

Francesco Burzotta, Carlo Trani, Filippo Crea, Giampaolo Niccoli, Flavia Belloni, Nicola Cosentino, Francesco Fracassi, Rocco Mongiardo, Italo Porto, Antonio Maria Leone

Risultato della ricerca: Contributo in rivistaArticolo in rivista

19 Citazioni (Scopus)

Abstract

Laser atherectomy might decrease procedural complications during percutaneous coronary intervention (PCI) of degenerated saphenous vein grafts (SVGs) in case of unstable or thrombotic lesions because of its ability to debulk and vaporize thrombus. We aimed at prospectively evaluating the safety and efficacy of excimer laser coronary angioplasty (ELCA) as a primary treatment strategy in consecutively unstable patients undergoing PCI of degenerated SVG lesions. Seventy-one consecutive patients with non-ST elevation acute coronary syndrome (mean age 69 ± 10 years, 66 men [89%]) undergoing PCI of degenerated SVG were enrolled in a prospective case-control registry, using 2 different distal protection devices (DPDs; FilterWire EZ [Boston Scientific, Natick, Massachusetts; n = 24] and SpiderRX [Ev3, Plymouth, Minnesota; n = 23]) or ELCA (n = 24). Primary end points of the study were incidence of angiographic microvascular obstruction (Thrombolysis In Myocardial Infarction flow grade of <3 or Thrombolysis In Myocardial Infraction flow grade of 3 with myocardial blush grade 1 to 2) and incidence of type IVa myocardial infarction. Angiographic microvascular obstruction incidence tended to be less in ELCA-treated patients compared with DPD-treated patients (3 [13%] vs 15 [32%], p = 0.09). Type IVa myocardial infarction incidence was more in DPD-treated patients compared with ELCA-treated patients (23 [49%] vs 5 [21%], p = 0.04). In conclusion, in patients with non-ST elevation acute coronary syndrome undergoing PCI of degenerated SVG, ELCA compared with DPD, is associated with a trend for better myocardial reperfusion and a lesser incidence of periprocedural necrosis. Controlled randomized trials are warranted to confirm these early observations.
Lingua originaleEnglish
pagine (da-a)1586-1591
Numero di pagine6
RivistaTHE AMERICAN JOURNAL OF CARDIOLOGY
Volume112
DOI
Stato di pubblicazionePubblicato - 2013

Keywords

  • Acute Coronary Syndrome
  • Aged
  • Angioplasty, Balloon, Coronary
  • Case-Control Studies
  • Coronary Angiography
  • Female
  • Follow-Up Studies
  • Graft Occlusion, Vascular
  • Humans
  • Laser Therapy
  • Lasers, Excimer
  • Male
  • Prognosis
  • Prospective Studies
  • Saphenous Vein

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