Laser balloon angioplasty: clinical, angiographic and histologic results.
Laser balloon angioplasty: clinical, angiographic and histologic results.
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激光球囊血管成形术：临床、血管造影和组织学结果。
DOI：
10.1016/s0735-1097(10)80240-2
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发表时间：
1991
影响因子：
24
通讯作者：
Safian,RD
中科院分区：
文献类型：
--
作者：
Reis,GJ;Pomerantz,RM;Jenkins,RD;Kuntz,RE;Baim,DS;Diver,DJ;Schnitt,SJ;Safian,RD
激光球囊血管成形术将传统的冠状动脉血管成形术与激光能量相结合，对血管组织进行瞬时加热。21例患者（56±13岁）行激光球囊血管成形术，其中常规血管成形术急性失败后紧急治疗10例，择期激光球囊血管成形术11例。常规血管成形术后，在激光球囊膨胀至4atm压力时，立即给予激光剂量（每次剂量为1至10剂量，每次剂量为205至380j）。10例常规血管成形术急性失败的患者中有7例（70%）通过激光球囊血管成形术治疗成功，但3例（30%）激光手术治疗失败，需要紧急冠状动脉搭桥手术。在所有三个失败中，3mm激光球囊血管成形术导管不是血管的最佳尺寸。11例选择性激光球囊血管成形术患者（参考直径2.94±0.22 mm），常规血管成形术后最小管腔直径从0.45±0.25 mm增加到1.85±0.46 mm，激光球囊血管成形术后增加到2.44±0.29 mm （p < 0.001）。这相当于血管狭窄从常规血管成形术前的84±9%下降到常规血管成形术后的35±16%，激光球囊血管成形术后的15±10% （p < 0.001）。本组无心肌梗死、紧急冠状动脉搭桥手术或死亡病例，无与激光能量传递相关的急性并发症。18例激光球囊血管成形术成功出院后，随访5.5±1.1个月进行冠状动脉造影。10例患者（56%）有血管造影再狭窄，定义为复发性直径狭窄（50%）。6例患者随后行定向冠状动脉粥样硬化切除术，发现内膜增生与常规血管成形术后再狭窄患者无异。总之，激光球囊血管成形术可以有效地封堵严重的冠状动脉夹层，并逆转常规血管成形术失败导致的突然闭塞。在简单的常规血管成形术后，激光球囊血管成形术可立即改善管腔尺寸，但再狭窄似乎是由内膜增生介导的，与常规血管成形术后类似。
Laser balloon angioplasty combines conventional coronary angioplasty with laser energy to transiently heat vascular tissue. Laser balloon angioplasty was performed in 21 patients (aged 56 ± 13 years), including 10 patients treated urgently after acute failure of conventional angioplasty and 11 patients treated with elective laser balloon angioplasty. Immediately after conventional angioplasty, laser doses (1 to 10 doses of 205 to 380 J each) were delivered during inflation of the laser balloon to a pressure of 4 atm.Seven (70%) of 10 patients with acute failure of conventional angioplasty were successfully treated with laser balloon angioplasty, but 3 (30%) were unsuccessfully treated with the laser procedure and required emergency coronary artery bypass surgery. In all three failures, the 3 mm laser balloon angioplasty catheter was not the optimal size for the vessel. In the 11 patients treated with elective laser balloon angioplasty (reference diameter 2.94 ± 0.22 mm), the minimal luminal diameter increased from 0.45 ± 0.25 to 1.85 ± 0.46 mm after conventional angioplasty and to 2.44 ± 0.29 mm after laser balloon angioplasty (p < 0.001). This corresponded to a decrease in diameter stenosis from 84 ± 9% before to 35 ± 16% after conventional angioplasty and to 15 ± 10% after laser balloon angioplasty (p < 0.001). There were no instances of myocardial infarction, emergency coronary artery bypass surgery or death and no acute complications related to delivery of laser energy in this group.Follow-up coronary angiography was performed 5.5 ± 1.1 months after laser balloon angioplasty in 18 patients discharged from the hospital after a successful procedure. Ten patients (56%) had angiographic restenosis, defined as recurrent diameter stenosis >50%. Six patients were subsequently treated by directional coronary atherectomy, which revealed intimai proliferation indistinguishable from that in patients with restenosis after conventional angioplasty.In conclusion, laser balloon angioplasty may be effective in sealing severe coronary dissections and reversing abrupt closure associated with failed conventional angioplasty. After uncomplicated conventional angioplasty, laser balloon angioplasty improves immediate luminal dimensions, but restenosis appears to be mediated by intimai hyperplasia, similar to that seen after conventional angioplasty.