Clinical laser revascularization of coronary obstruction with the coaxial-guided laser-heated metal cap catheter

Highly Nd3+-doped Y3Al5O12 crystal fiber tip for laser thermotherapy

Based on phonon relaxation, a 12-at. % neodymium-doped YAG (Y3AlrO12) crystal fiber tip has been developed for photothermal conversion. The near-cylindrical tip, with an average diameter of 0.68 mm and a length of 1.8 mm, is fabricated on a 0.65-mm-thick 220-mm-long pure YAG single-crystal fiber by laser-heated growth. Pumped by an 810-nm wavelength diode laser with a pump power of less than 2 W, the temperatures of the tip reach 725 degrees C in air, 78 degrees C in egg white, and 79 degrees C in porcine liver, with acceptable reproducibilities and thermal response times. The photothermal conversion efficiency of the doped tip is approximately 89%, and the high stability of the tip is also proved. Experimental results show that the doped fiber tip is promising for laser thermotherapy applications.

Thermal effects of stationary "hot tip" laser coronary probes: an in vitro assessment

Percutaneous laser thermal probe angioplasty requires sufficient laser probe flexibility to access the coronary tree. This may entail a loss of axial strength and the resultant slow advancement may lead to unwanted heating of the normal coronary artery proximal to the lesion. To assess the lateral thermal effects of stationary coronary laser probes, laser thermal energy (50-150 J) was delivered to 25 coronary artery segments (diameter 1.9-4.0 mm) in a perfused cadaver heart preparation using a 1.7 mm tip probe. Adherence to the vessel wall occurred in 19 segments, endothelial charring in 8 segments, and perforation in 3 segments. Endothelial charring was seen in 8 of 13 nonperfused segments but in 0 of 12 segments perfused at 60 ml/minute (P less than 0.01). In all three perforations the vessel to probe diameter ratio was less than 1.6:1, perfusion was absent, and traction to dislodge the adherent probe was necessary. Lateral wall damage is a complication of stationary laser probes: smaller-tipped probes which are advanced rapidly at the time of energy delivery may enhance the safety margins of coronary laser thermal probe angioplasty.