Percutaneous Atherectomy Catheters

Comparative study of Nd:YAG laser angioplasty at 1.06 microns, 1.32 microns, and 1.44 microns wavelengths: decreased vascular spasm and early mortality with 1.44 microns laser ablation

BACKGROUND AND OBJECTIVE

Although laser angioplasty has been demonstrated to be effective for the treatment of long, complex coronary arterial atherosclerotic stenoses, there is an associated risk of acute arterial spasm, dissection, and perforation as well as a significant restenosis rate. It has been postulated that the use of lasers emitting at wavelengths designed for radiation absorption by water would decrease local tissue trauma.

STUDY DESIGN/MATERIALS AND METHODS

We have examined the use of a Nd:YAG laser designed to emit at 1.44 microns, an absorption peak for water, and compared the results of laser ablation at 1.06 microns, 1.32 microns, and 1.44 microns wavelengths. Nd:YAG laser angioplasty was performed in the abdominal aorta of White Leghorn roosters. Acute and chronic vascular trauma was assessed by contrast angiography and histological analysis.

RESULTS

There was a significant decrease in early mortality with 1.44 microns laser ablation. This decreased mortality after 1.44 microns ablation was associated with a decrease in vascular spasm, perforation, and thermal damage. Atherosclerotic plaque development at follow up was decreased with 1.44 microns ablation but this was not significant.

CONCLUSION

1.44 microns laser ablation decreases early vascular trauma and mortality and may decrease subsequent atherosclerotic plaque development.

Options for percutaneous coronary and peripheral revascularization

Angioplasty has become an established treatment for both coronary and peripheral atherosclerosis, and a number of new techniques and devices promise to improve the results of percutaneous intervention during the coming decades. It is likely that balloon angioplasty will remain the percutaneous treatment of choice for both coronary and peripheral intervention; however, we look with hope toward the development of new devices that will expand the role of percutaneous angioplasty and improve the long-term success of these procedures. As technical expertise grows with the new procedures, prospective randomized trials comparing them with standard PTCA will be required to enable physicians to judge their clinical utility.

Effects of rotational atherectomy in normal canine coronary and diseased human cadaveric arteries: potential for plaque removal from distal, tortuous, and diffusely diseased vessels

To test the hypothesis that tortuous, diseased vessels could be successfully treated with a flexible rotational atherectomy device we evaluated the BARD atherectomy device with quantitative angiography and histology in normal canine coronary arteries and diseased human below-knee amputation specimens. The mid left anterior descending and the circumflex vessels were treated in 4 dogs serially with 1 wk separating treatments. The acute and follow-up anterior descending artery size was unchanged (1.41 mm before, 1.39 mm after, and 1.59 mm at 1 week). Similar findings were obtained in the circumflex vessels. In 4 adult human amputated legs, diseased peroneal or tibial arteries were treated with a significant reduction in the percent luminal diameter stenosis from 62.75 prior to intervention to 36.5 following intervention (p = 0.021). The luminal diameter increased from 0.81 to 1.54 mm (p = 0.06). In 2 canine arteries there was histologic evidence of localized perforation of the arterial wall, but there was no angiographic evidence of perforation or dissection and no significant myocardial necrosis in the distribution of the treated vessels at 1 wk. The majority of the diseased human vessels demonstrated smoothly cut atheromas with sparing of the media. The rotational atherectomy catheter system holds promise for removal of plaque in relatively small, diffusely diseased, tortuous vessels.