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Abstract
This review gives a short overview of the results of 15 years of experimental and clinical work on laser angioplasty. Experimentally, photothermal and photomechanical ablation of plaque could be demonstrated. However, laser angioplasty did not cause reduction of platelet adhesion and intimal hyperplasia. Clinically, the technique of laser angioplasty was continuously improved until the initial recanalization rates and long-term patency rates in femoropopliteal artery occlusions were the same as the success rates of percutaneous transluminal angioplasty (PTA). This was proven by various randomized studies. Currently, laser angioplasty cannot be proposed as a routine procedure because it is an expensive technology. However, laser recanalization and debulking of total occlusions should be further developed, especially in combination with endoluminal graft placement.
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Affiliation(s)
- J Lammer
- Department of Angiography and Interventional Radiology, University Vienna, Austria
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2
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Mitchell DC, Smith RE, Wood RFM. Laser angioplasty: Useful tool or interesting toy? Lasers Med Sci 1994. [DOI: 10.1007/bf02594179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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3
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Laser angioplasty of peripheral vessels: complementary procedures. Eur Radiol 1992. [DOI: 10.1007/bf00714182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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4
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Mitchell DC, Murray A, Wood RF, Grasty M, Smith RE, Dacie JE, Walters TK, Cotton G. Laser-assisted angioplasty for arterial occlusion of the lower limb: initial results and follow-up. Br J Surg 1992; 79:81-5. [PMID: 1737287 DOI: 10.1002/bjs.1800790129] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
A flashlamp-pumped pulsed dye laser operating at either 480 or 504 nm, coupled to an integral ball-tipped optical fibre, was used to recanalize occluded lower limb arteries. All channels created by the laser were augmented with balloon dilatation. We have treated 78 limbs in 71 patients; 46 limbs (59 per cent) had rest pain and 22 (48 per cent) of these had tissue loss. The median occlusion length was 18 (range 0.5-58) cm. Technical success was achieved in 58 limbs (74 per cent) with clinical success in 46 (59 per cent). Success rates fell with increasing length of occlusion. Two patients died in the perioperative period. A subgroup of 22 patients with marked discrete arterial calcification had a lower technical success rate than the subgroup without calcification (50 per cent versus 84 per cent, P less than 0.01). Both subgroups displayed a similar pattern of reclosure during follow-up. The cumulative patency rate after technical success was 67 per cent at 6 months and 45 per cent at 12 months. Forty-six (59 per cent) limbs avoided bypass surgery or amputation. Laser-assisted angioplasty may offer an alternative to femoropopliteal bypass, although the former procedure is not as durable.
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Affiliation(s)
- D C Mitchell
- Professorial Surgery Unit, St. Bartholomew's Hospital, London, UK
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5
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Tobis JM, Conroy R, Deutsch LS, Gordon I, Honye J, Andrews J, Profeta G, Chatzkel S, Berns M. Laser-assisted versus mechanical recanalization of femoral arterial occlusions. Am J Cardiol 1991; 68:1079-86. [PMID: 1833969 DOI: 10.1016/0002-9149(91)90499-b] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
A randomized clinical trial was performed to test the hypothesis that a laser-heated probe is superior to standard techniques to reopen occluded femoral arteries. Twenty patients were treated with a standard guidewire and balloon dilation method. In a second group of 20 patients, the laser probe was initially used as a nonheated mechanical device. If the probe was unsuccessful in mechanically reopening the artery, an Argon laser was activated to heat the probe. The mean length of occlusion was 15.9 +/- 10.3 cm. The success rate for the laser probe was 15 of 20 (75%), which was not significantly different from the standard method, 19 of 20 (95%). Most of the success in the laser-probe group was due to the probe's mechanical properties. The laser probe was successful as a cold, mechanical device in 13 of 15 (87%) arteries. It was necessary to heat the probe in 5 patients. When heated, the laser probe assisted recanalization in 2 but perforated the artery in 3 cases. The results of this randomized trial do not support the hypotheses behind the use of the thermal laser probe. The laser probe functions primarily as a mechanical device. The thermal activation does not significantly improve the success rate without increasing the risk of perforation. This small additional benefit does not justify the large cost of current thermal laser devices. This controlled study also demonstrates a higher success rate in long occlusions than previous reports of mechanical balloon recanalization. This is due to a combination approach of retrograde and anterograde probing of the occluded segment.
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Affiliation(s)
- J M Tobis
- Division of Cardiology, University of California, Irvine
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6
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Arlart IP, Gerlach A, Grass HG. Laser-assisted balloon angioplasty in complete femoropopliteal occlusions: preliminary results. Cardiovasc Intervent Radiol 1991; 14:233-7. [PMID: 1833059 DOI: 10.1007/bf02578468] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Laser-assisted balloon angioplasty (LA) using a Nd-YAG laser with a sapphire tip probe was performed in 40 selected patients with complete chronic femoropopliteal occlusions (SFA n = 30, PA n = 10), in whom the lesion was resistant to conventional guidewire/catheter traversal. Overall technical success rate was 77.5% (31/40). Technical failure occurred in nine cases due to calcifications (n = 2), imminent perforation (n = 5), or complete perforation (n = 4). In 1 case a Simpson atherectomy was done following LA. In addition, 3 cases of peripheral embolizations were managed successfully by selective fibrinolysis and thrombus aspiration. Follow-up studies up to 14 months demonstrated a clinical improvement in 87% (27/31). Early reocclusion rate was 4/31; after 2-14 months, reocclusion rate was 7/31. Our results demonstrate that LA may be recommended for chronic occlusions resistant to conventional guidewire or catheter traversal in spite of a relatively high rate of technical failure and complications, and recurrence.
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Affiliation(s)
- I P Arlart
- Radiologisches Institut, Katharinenhospital Stuttgart, FRG
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Torres JH, Ghaffari S, Welch AJ. Laser probe temperature control by measuring the returning infra-red radiation. Med Biol Eng Comput 1990; 28:1-7. [PMID: 2325445 DOI: 10.1007/bf02441670] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The metal-tipped fibre or 'laser probe' developed for angioplasty comprises a metallic probe at the end of an optical fibre. The probe is heated by an argon or Nd:YAG laser and applied against the tissue to be vapourized. The heated probe generates infra-red radiation which is proportional to the temperature of the probe. The paper investigates the feasibility of a feedback control system that measures the temperature of the probe by detecting the infra-red radiation transmitted back through the fibre. The probe was initially heated by physical contact with a hot surface, and then by an argon laser via the optical fibre. The returning IR radiation was sensed by a lead sulphide detector, while probe temperature was simultaneously measured by a thermocouple. Temperatures as low as 200 degrees C were measured through a 5 m long fibre during the laser heating of the probe. The detector signal increased in an exponential fashion as the probe temperature increased. A resolution of 1 degree C was obtained at a probe temperature of 400 degrees C. It can be concluded that, for the laser probe, it is feasible to use a feedback control system which measures the infra-red radiation transmitted back through the same fibre that carries the heating laser light.
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Affiliation(s)
- J H Torres
- University of Texas, Biomedical Engineering Program, Austin 78712
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8
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LEE GARRETT, ARGENAL AGUSTINJ, WIXSON DAVID, LEE MARSHALLH, LEE KELVINK, KOZINA JOSEPH, MASON DEANT. Laser-Thermal Recanalization Using Short Interrupted Bursts of Energy in Peripheral Arterial Occlusions. J Interv Cardiol 1989. [DOI: 10.1111/j.1540-8183.1989.tb00776.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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9
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Chan MC, Lee G, Guo JX, Mao JM, Chen FR, Yan WD, Xie DY, Rink DL, Argenal AJ, Mason DT. Percutaneous coronary laser angioplasty using quick short bursts of laser thermal energy for chronic total occlusions. Am J Cardiol 1989; 64:940-2. [PMID: 2801565 DOI: 10.1016/0002-9149(89)90849-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- M C Chan
- Beijing Medical University, China
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Perler BA, Osterman FA, White RI, Williams G. Percutaneous laser probe femoropopliteal angioplasty: A preliminary experience. J Vasc Surg 1989. [DOI: 10.1016/0741-5214(89)90452-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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11
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Lee G, Low RI, Argenal AJ, Sommerhaug RG, Chan MC, Mason DT. Laser Angioplasty of the Coronary Arteries. Interv Cardiol 1989. [DOI: 10.1007/978-1-4612-3534-7_27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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12
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Transcatheter laser angioplasty and related techniques guided by echocardiography. ACTA ACUST UNITED AC 1989. [DOI: 10.1007/978-94-009-0907-6_10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
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13
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LEE GARRETT, CHAN MINGC, REIS ROBERTL, ARGENAL AGUSTINJ, LOW REGINALDI, MASON DEANT. Potential Applications of Lasers in the Management of Cardiovascular Diseases. J Interv Cardiol 1988. [DOI: 10.1111/j.1540-8183.1988.tb00390.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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14
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DE FEYTER PIMJ, VAN DEN BRAND MARCEL, SERRUYS PATRICKW, SURYAPRANATA HARRY, BEATT KEVIN, ZIJLSTRA FELIX, VAN DOMBURG RON, PATIJN MAX. Increase of Initial Success and Safety of Single-Vessel Percutaneous Transluminal Coronary Angioplasty in 1371 Patients: A Seven-Year Experience. J Interv Cardiol 1988. [DOI: 10.1111/j.1540-8183.1988.tb00384.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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15
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Lawrence PF, Kercher JM, Dries DJ, Peric-Golia L, Dixon JA. Endoscopic laser resection of atherosclerotic plaque in a live animal model. J Vasc Surg 1987. [DOI: 10.1016/0741-5214(87)90305-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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16
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Borst C. Percutaneous recanalization of arteries: Status and prospects of laser angioplasty with modified fibre tips. Lasers Med Sci 1987. [DOI: 10.1007/bf02594152] [Citation(s) in RCA: 31] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Yang Y, Hashizume M, Arbutina D, Milewski LF, DuPree J, Matsumoto T. Argon laser angioplasty with a laser probe. J Vasc Surg 1987; 6:60-5. [PMID: 3599282 DOI: 10.1067/mva.1987.avs0060060] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
A preliminary basic study of argon laser angioplasty with the use of a specially designed probe is presented. Arterial specimens were harvested from 10 amputated lower extremities. The studies included the evaluation of coaxial laser angioplasty in 10 partially or totally occluded arteries; the observation of the effect of perpendicularly applied laser energy on 35 thrombi, 54 soft and 10 hard atherosclerotic, and 51 normal arterial walls; the comparison of laser energy requirements for coaxial vessel lumen enlargement or recanalization vs. perpendicular penetration in 10 occluded, hard atherosclerotic arteries; and the spectrographic analysis of calcium density gradient in two specimens. The results showed that the power required for vessel lumen enlargement was 10 +/- 6 J/mm of atherosclerotic vessel (mean +/- standard deviation). The probe followed the original arterial lumen, did not perforate the vessel wall, and created a smooth, enlarged path. The power required to penetrate perpendicularly to a similar depth for thrombi, soft and hard atherosclerotic plaques, and normal arterial walls was 15 +/- 4, 30 +/- 15, 65 +/- 32, and 246 +/- 123 J/mm, respectively. In the hard calcified specimens, laser energy required for coaxial lumen enlargement or recanalization was significantly less than that for perpendicular penetration (p less than 0.05), which correlated with the calcium density map indicating an increase from inside to outside.
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Lee G, Chan MC, Rink DL, Beerline D, Lee MH, Reis RL, Mason DT. Coronary revascularization by a new coaxially-guided laser-heated metal cap system. Am Heart J 1987; 113:1507-8. [PMID: 3591618 DOI: 10.1016/0002-8703(87)90668-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Abstract
Arteriosclerotic arteries have been shown to fluoresce when treated with hematoporphyrin derivative. This study investigates the incorporation and distribution of a partially purified form of hematoporphyrin derivative (Photofrin II) in normal and arteriosclerotic rabbit aortas. A thoracoabdominal exploration was performed in 15 rabbits. Group I comprised normal rabbits, Group II normal rabbits given 5 mg/kg Photofrin II 48 hours before surgery, Group III arteriosclerotic rabbits and Group IV arteriosclerotic rabbits given 5 mg/kg Photofrin II 48 hours before surgery. Multiple aortic biopsy specimens for frozen section were taken from all rabbits. In addition, open laser endarterectomy (with an argon ion laser) was performed on Group III and Group IV rabbits. Frozen sections were studied by digital video fluorescence microscopy to determine the distribution of Photofrin II within the layers of the aortic wall. The fluorescence of the intima of Group IV rabbits was found to be significantly greater than that of the intima, internal elastic lamina, media or adventitia of the other groups (p less than 0.01) and significantly greater than that of the internal elastic lamina, media or adventitia of Group IV rabbits (p less than 0.01). When open laser endarterectomy was performed, Group III rabbits required 103 +/- 14 J/cm2 and Group IV required 33 +/- 3 J/cm2 (p less than 0.01). It is concluded that porphyrins are selectively localized within the intima of arteriosclerotic arteries. This localization sensitizes atheromas to argon ion laser light and facilitates laser endarterectomy.
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Lee G, Reis RL, Boggan MD, Chan MC, Lee MH, Low RI, Hannah H, Mason DT. Laser recanalization in severe end-stage peripheral vascular disease. Am J Cardiol 1987; 59:386-7. [PMID: 3812302 DOI: 10.1016/0002-9149(87)90830-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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21
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Theis JH, Lee G, Chan MC, Ikeda RM, Lee MH, Rink JL, Steffey EP, Thomas WP, Mason DT. Effects of simultaneous viewing and vaporization of plaques using the steerable, laser-heated metal cap in the atherosclerotic monkey model. Lasers Surg Med 1987; 7:414-20. [PMID: 3695784 DOI: 10.1002/lsm.1900070507] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
A steerable, fiberoptic catheter coupled to a laser light guide tipped with a metal cap was used. Four monkeys fed an atherogenic diet for 7-8 years were angiographed and were found to have extensive mural plaque in the iliac arteries. Plaque sites in these monkeys were vaporized using the laser-heated metal cap. Energies of 1.5-9 Joules were employed. Application of the energy was tangential of perpendicular to the plaque. Lased sites were examined histologically at 24 hr or at 3 months after treatment. No effect was seen at 1.5 Joules. Three to six Joules tangentially produced a superficial lesion that extended into the tunica intima. Six Joules perpendicularly produced a burn into the tunica adventitia, with damage to the vasavasorum. Nine Joules tangentially produced a burn into the tunica media. Three months after treatment, this lased site showed no stenosis or aneurysm formation.
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Affiliation(s)
- J H Theis
- School of Medicine, University of California, Davis 95616
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Lee G, Garcia JM, Chan MC, Corso PJ, Bacos J, Lee MH, Pichard A, Reis RL, Mason DT. Clinically successful long-term laser coronary recanalization. Am Heart J 1986; 112:1323-5. [PMID: 3491532 DOI: 10.1016/0002-8703(86)90370-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Lee G, Reis RL, Chan MC, Boggan MD, Lee MH, Low RI, Argenal A, Hannah H, Mason DT. Clinical laser recanalization of coronary obstruction. Angioscopic and angiographic documentation. Chest 1986; 90:770-2. [PMID: 3769584 DOI: 10.1378/chest.90.5.770] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Coronary angioscopy was used to assess the configuration and cross-sectional luminal area of atherosclerotic obstruction prior to and following laser recanalization in a patient at the time of bypass surgery. Angioscopy served as a useful adjunct to angiography by providing documentation of immediate improvement and patency of the laser-recanalized site.
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Prince MR, Deutsch TF, Mathews-Roth MM, Margolis R, Parrish JA, Oseroff AR. Preferential light absorption in atheromas in vitro. Implications for laser angioplasty. J Clin Invest 1986; 78:295-302. [PMID: 3722380 PMCID: PMC329561 DOI: 10.1172/jci112564] [Citation(s) in RCA: 113] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Laser angioplasty, the in situ ablation of arterial obstructions with laser radiation, has been demonstrated in animal models and early clinical trials. A problem with this technique, however, is the possibility of thermal damage to adjacent or underlying normal tissues that also absorb the radiation. Using a spectrophotometer with an integrating sphere and a specially constructed tunable-dye laser-based spectrophotometer, we evaluated the transmittance and remittance of human cadaveric atheromas and adjacent normal aorta from 250 to 1,300 nm to identify wavebands where there is preferential light absorption by atheromas. Data were analyzed by both the Kubelka-Munk formalism and a Beer's law model. Both methods indicate that atheromas absorb more than normal aorta between 420 and 530 nm. At 470 nm the average Kubelka-Munk absorption coefficient of atheromas from 10 cadavers was 54 +/- 9 cm-1 compared with 26 +/- 6 cm-1 for normal aortic specimens from seven cadavers. Yellow chromophores responsible for the atheroma absorbance were extractable with xylenes. Thin-layer chromatography and absorption spectra identified the extracted chromophores as predominantly consisting of a mix of carotenoids, which are known constituents of atheromatous lesions. Preferential absorption of blue light by carotenoids in atheromas may permit selective ablation of atheromatous obstructions with appropriate pulses of laser radiation.
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Lee G, Chan MC, Ikeda RM, Rink JL, Lee MH, Dukich J, Reis RL, Mason DT. Intravascular steerable guidewire for fiberoptic laser-heated metal cautery cap in dissolution of human atherosclerotic coronary disease. Am Heart J 1985; 110:1304-6. [PMID: 4072889 DOI: 10.1016/0002-8703(85)90033-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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26
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Slager CJ, Essed CE, Schuurbiers JC, Bom N, Serruys PW, Meester GT. Vaporization of atherosclerotic plaques by spark erosion. J Am Coll Cardiol 1985; 5:1382-6. [PMID: 3158688 DOI: 10.1016/s0735-1097(85)80352-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
An alternative to the laser irradiation of atherosclerotic lesions has been developed. A pulsed electrocardiogram R wave-triggered electrical spark erosion technique is described. Controlled vaporization of fibrous and lipid plaques with minimal thermal side effects was achieved and documented histologically in vitro from 30 atherosclerotic segments of six human aortic autopsy specimens. Craters with a constant area and a depth that varied according to the duration of application were produced. The method was confirmed to be electrically safe during preliminary in vivo trials in the coronary arteries of seven anesthetized pigs. The main advantages of this technique are that it is simpler to execute than laser irradiation and potentially more controllable.
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27
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Lee G, Chan MC, Ikeda RM, Lee MH, Reis RL, Rink JL, Dukich J, Bommer WJ, Hanna ES, Mason DT. Laser Therapy of Coronary Artery Obstructions. Cardiol Clin 1985. [DOI: 10.1016/s0733-8651(18)30700-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Abela GS, Fenech A, Crea F, Conti CR. "Hot tip": another method of laser vascular recanalization. Lasers Surg Med 1985; 5:327-35. [PMID: 4010444 DOI: 10.1002/lsm.1900050315] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
UNLABELLED This study is a preliminary report evaluating the use of laser radiation to heat a metal-capped fiber for arterial recanalization. The method was compared to the currently used bare-ended fiber for recanalization of occluded vessels. The model used was a human coronary artery xenograft transplanted in the femoral artery of the dog. At 4 weeks following the transplantation, laser recanalization was attempted using the heated metal probe ("hot tip") in five arteries and the bare fiber in another five arteries. RESULTS 1) Angiography demonstrated recanalization in all five arteries treated with the "hot tip" and three of the five arteries treated with the bare fiber. 2) Only one perforation occurred with the "hot tip," whereas three perforations occurred with the bare fiber. 3) The larger metal cap was capable of creating a wider channel in the occluded arterial segment. Although the trend favored the heated metal cap in terms of recanalization and less perforation than the bare fiber, the total number of experiments were not adequate to demonstrate statistical significance. Microscopic examination of the vessels recanalized by either technique was similar. Characteristic charring at the recanalization site was seen regardless of the technique used. These observations suggest that the effect of direct laser radiation on plaques is predominantly a thermal effect. Although these results would suggest utilization of a metal-capped fiber for vascular recanalization, more studies need to be done to confirm these preliminary findings.
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Abela GS, Fenech A, Crea F, Richard Conti C. “Hot tip”: Another method of laser vascular recanalization. Lasers Surg Med 1985. [DOI: 10.1002/lsm.1900050415] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Lee G, Rubinson R, Chan MC, Stobbe D, Reis RL, Mason DT. Dissolution of pulmonary carcinoma via argon-laser bronchoscopy. First clinical use of fiberoptic metal cautery cap heated by laser radiation. Chest 1984; 85:708-9. [PMID: 6713985 DOI: 10.1378/chest.85.5.708] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
A 60-year-old man with nonresectable lung cancer underwent bronchoscopy which revealed a large squamous cell tumor mass narrowing the free airway to the left lung. A flexible quartz fiber connected to an argon ion laser was then inserted through a hollow channel of the fiberoptic bronchoscope. The laser was activated to heat the metal cap on the distal tip of the fiber to thermally dissolve the mass and relieve airway obstruction.
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