Clinical and angiographic outcome in the laser angioplasty for restenotic stents (LARS) multicenter registry
Corresponding Author
Satyendra Giri MD
Division of Cardiology, Brigham and Women's Hospital, Boston, Massachusetts
L2, Cardiac Catheterization Laboratory, Brigham & Women's Hospital, 75 Francis Street, Boston, MA 02215Search for more papers by this authorShigenori Ito MD
Department of Internal Medicine, Cardiology Divisions, Washington Hospital Center, Washington, D.C.
Search for more papers by this authorPaul Gilmore MD
University Medical Center, Jacksonville, Florida
Search for more papers by this authorFrank Cummins MD
Milwaukee Heart and Vascular Institute, Milwaukee, Wisconsin
Search for more papers by this authorKenneth M. Kent MD, PhD
Department of Internal Medicine, Cardiology Divisions, Washington Hospital Center, Washington, D.C.
Search for more papers by this authorLowell F. Satler MD
Department of Internal Medicine, Cardiology Divisions, Washington Hospital Center, Washington, D.C.
Search for more papers by this authorAugusto D. Pichard MD
Department of Internal Medicine, Cardiology Divisions, Washington Hospital Center, Washington, D.C.
Search for more papers by this authorHongsheng Wu PhD
Department of Internal Medicine, Cardiology Divisions, Washington Hospital Center, Washington, D.C.
Search for more papers by this authorAnn Greenberg
Department of Internal Medicine, Cardiology Divisions, Washington Hospital Center, Washington, D.C.
Search for more papers by this authorTheresa A. Bucher
Department of Internal Medicine, Cardiology Divisions, Washington Hospital Center, Washington, D.C.
Search for more papers by this authorWilliam Kerker
Department of Internal Medicine, Cardiology Divisions, Washington Hospital Center, Washington, D.C.
Search for more papers by this authorAndrea S. Abizaid MD
Department of Internal Medicine, Cardiology Divisions, Washington Hospital Center, Washington, D.C.
Search for more papers by this authorJorge Saucedo MD
Department of Internal Medicine, Cardiology Divisions, Washington Hospital Center, Washington, D.C.
Search for more papers by this authorJeffrey J. Popma MD
Division of Cardiology, Brigham and Women's Hospital, Boston, Massachusetts
Search for more papers by this authorCorresponding Author
Satyendra Giri MD
Division of Cardiology, Brigham and Women's Hospital, Boston, Massachusetts
L2, Cardiac Catheterization Laboratory, Brigham & Women's Hospital, 75 Francis Street, Boston, MA 02215Search for more papers by this authorShigenori Ito MD
Department of Internal Medicine, Cardiology Divisions, Washington Hospital Center, Washington, D.C.
Search for more papers by this authorPaul Gilmore MD
University Medical Center, Jacksonville, Florida
Search for more papers by this authorFrank Cummins MD
Milwaukee Heart and Vascular Institute, Milwaukee, Wisconsin
Search for more papers by this authorKenneth M. Kent MD, PhD
Department of Internal Medicine, Cardiology Divisions, Washington Hospital Center, Washington, D.C.
Search for more papers by this authorLowell F. Satler MD
Department of Internal Medicine, Cardiology Divisions, Washington Hospital Center, Washington, D.C.
Search for more papers by this authorAugusto D. Pichard MD
Department of Internal Medicine, Cardiology Divisions, Washington Hospital Center, Washington, D.C.
Search for more papers by this authorHongsheng Wu PhD
Department of Internal Medicine, Cardiology Divisions, Washington Hospital Center, Washington, D.C.
Search for more papers by this authorAnn Greenberg
Department of Internal Medicine, Cardiology Divisions, Washington Hospital Center, Washington, D.C.
Search for more papers by this authorTheresa A. Bucher
Department of Internal Medicine, Cardiology Divisions, Washington Hospital Center, Washington, D.C.
Search for more papers by this authorWilliam Kerker
Department of Internal Medicine, Cardiology Divisions, Washington Hospital Center, Washington, D.C.
Search for more papers by this authorAndrea S. Abizaid MD
Department of Internal Medicine, Cardiology Divisions, Washington Hospital Center, Washington, D.C.
Search for more papers by this authorJorge Saucedo MD
Department of Internal Medicine, Cardiology Divisions, Washington Hospital Center, Washington, D.C.
Search for more papers by this authorJeffrey J. Popma MD
Division of Cardiology, Brigham and Women's Hospital, Boston, Massachusetts
Search for more papers by this authorAbstract
In-stent restenosis (ISR), when treated with balloon angioplasty (PTCA) alone, has an angiographic recurrence rate of 30%–85%. Ablating the hypertrophic neointimal tissue prior to PTCA is an attractive alternative, yet the late outcomes of such treatment have not been fully determined. This multicenter case control study assessed the angiographic and clinical outcomes of 157 consecutive procedures in 146 patients with ISR at nine institutions treated with either PTCA alone (n = 64) or excimer laser assisted coronary angioplasty (ELCA, n = 93)) for ISR. Demographics were similar except more unstable angina at presentation in ELCA-treated patients (74.5% vs. 63.5%; P = 0.141). Lesions selected for ELCA were longer (16.8 ± 11.2 mm vs. 11.2 ± 8.6 mm; P < 0.001), more complex (ACC/AHA type C: 35.1% vs. 13.6%; P < 0.001), and with compromised antegrade flow (TIMI flow < 3: 18.9% vs. 4.5%; P = 0.008) compared to PTCA-treated patients. ELCA-treated patients had similar rate of procedural success [93 (98.9% vs. 62 (98.4%); P = 1.0] and major clinical complications [1 (1.1%) vs. 1 (1.6%); P = 1.0]. At 30 days, repeat target site coronary intervention was lower in ELCA-treated patients (1.1% vs. 6.4% in PTCA-treated patients; P = 0.158), but not significantly so. At 1 year, ELCA-treated patients had similar rate of major cardiac events (39.1% vs. 45.2%; P = 0.456) and target lesion revascularization (30.0% vs. 32.3%; P = 0.646). These data suggest that ELCA in patients with complex in-stent restenosis is as safe and effective as balloon angioplasty alone. Despite higher lesion complexity in ELCA-treated patients, no increase in event rates was observed. Future studies should evaluate the relative benefit of ELCA over PTCA alone for the prevention of symptom recurrence specifically in patients with complex in-stent restenosis. Cathet Cardiovasc Intervent 2001;52:24–34. © 2001 Wiley-Liss, Inc.
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