Holmium:YAG coronary laser angioplasty: lessons learned from a large clinical experience

The latest, most advanced laser device is the compact size, solid-state holmium:YAG (Eclipse 2100, Eclipse Surgical Technologies, Palo Alto, CA.) which is currently applied in a multicenter clinical observation study. The device emits 250-600 mJ/pulse, with a pulse length of 250 microseconds at 5 Hz. Five sizes of catheters are available: 1.2, 1.4, 1.5, 1.7 and 2.0 mm. Indications for its utilization include total and subtotal stenoses that fail to be crossed and dilated by a conventional balloon, restenosed lesions, calcified plaques, saphenous vein graft stenosis, ostial stenoses and thrombolysis and plaque ablation in acute myocardial infarction. The results of the initial 787 cases (858 lesions) of holmium:YAG laser coronary angioplasty have recently been reported. 93% procedural success was achieved. The laser reduced the stenosis from 89±10% to 61±22% and adjunct balloon angioplasty resulted in 23% residual stenosis. Complications included death 0.6%, emergency CABGS 3.4%, acute M.I. 3.4%, dissection 9.7%, perforation 2.2%, acute closure 3.7% and spasm 11.5%. At six months repeat angiography in 185 lesions revealed a 42% restenosis rate. At our medical center we have performed 107 coronary laser procedures (92% complex lesions) from October 1991 to May 1993. While success rate was 93% similar to that of the multicenter study, the rate of major complications was significantly lower. There were 0% deaths, 0% perforation, 0.9% emergency CABGS, 1.8% acute MI (only non-Q), 5% dissection and 4% spasm. We attribute this low complication rate to the new lasing technique which we have introduced, called "Pulse and Retreat"