Revascularization of chronic coronary artery occlusions using laser debulking followed by stent implantation.

Objective: Chronic total occlusions are considered unfavourable for percutaneous balloon angioplasty because of the low rate of success and the high rate of restenosis. Stent implantation after recanalization of chronic total occlusions has been shown to reduce restenosis and reocclusion rates compared with balloon angioplasty in recently published randomized trials. However, it is not well known whether laser debulking before stent implantation would improve the benefit of stenting in chronic total occlusions.

Methods And Results: We analysed procedural and long-term clinical and angiographic follow-up results of 48 patients who underwent laser angioplasty followed by stent implantation for chronic total occlusions. The procedure was completed successfully in 46 patients (95.8%) in whom the lesion was crossed with a guidewire. We implanted 51 stents in 46 chronic total occlusions following laser debulking. During in-hospital follow-up 1 patient (2.1%) had Q wave, and 4 patients (8.7%) had non-Q wave myocardial infarction. Nine patients (19.5%) had repeat angioplasty for restenosis and one (2.1%) underwent coronary bypass operation at 6 months follow-up. Death or Q wave myocardial infarction did not occur during 6-month follow-up. Thirty-nine patients (85%) had angiographic follow-up at 6 months, and stent restenosis was found in 17 (44%) patients.

Conclusion: These high rates of restenosis and target vessel revascularization in our study suggest that laser debulking before stent implantation does not improve clinical and angiogragic outcomes in chronic total occlusions.