Six-Month Angiographic and Clinical Outcomes after Successful Eccentric Excimer Laser Coronary Angioplasty with Adjunctive Cutting Balloon Angioplasty for Recurrent In-Stent Restenosis

Background: There was no study yet surveying the efficacy & safety of eccentric excimer laser angioplasty (ELCA) with cutting balloon angioplasty (CBA) in patients with repeat in-stent restenosis (ISR). Methods: Thirty-five patients (40 lesions) with repeat in-stent restenosis were recruited between May 2004 and June 2005. All patients received ELCA+CBA. Coronary angiogram was followed 6 months later. Five patients had received graft stents for previous coronary perforation. Four patients were excluded due to missing angiograms. Results: Left anterior descending artery, left circumflex, and right coronary artery lesions were 22, 8, and 6 in number, respectively. The stent length, stent diameter, and lesion length were 20.03±4.99 mm, 3.17±0.34 mm, and 14.13±8.00 mm, respectively. The minimal lumen diameter increased from 0.79±049 mm before treatment to 1.95±0.52 mm after eccentric ELCA, and 2.65±0.31 mm after CBA, but had declined to 1.25±1.05 at 6 months. The diameter stenosis decreased from 74±16% before intervention to 32±14% after laser surgery, and 16±18% after CBA, but later increased to 60±32%. The overall restenosis rate was 56%. The recurrent restenosis rates in ISR with lesion length＜9 mm and in ISR with lesion length≧9 mm were 23% and 74%, respectively. Excluding graft stent lesions, the overall restenosis rates, was 42%. The acute gains were 1.16±0.63 mm and 1.96±0.5 mm after laser and cutting balloon angioplasty, respectively. The late loss was 1.4±1.0 mm. There were no major adverse cardiovascular events during hospitalization. Conclusion: ELCA+CBA can be safely and effectively used in patients with recurrent focal ISR.