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Kanno D, Tsuchikane E, Nasu K, Katoh O, Kashima Y, Kaneko U, Fujita T, Suzuki Y, Suzuki T. Initial results of a first-in-human study on the PlasmaWire™ System, a new radiofrequency wire for recanalization of chronic total occlusions. Catheter Cardiovasc Interv 2017; 91:1045-1051. [PMID: 28980430 DOI: 10.1002/ccd.27333] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 08/01/2017] [Accepted: 08/20/2017] [Indexed: 11/09/2022]
Abstract
OBJECTIVES To examine the safety, efficacy, and efficiency of the PlasmaWireTM System to recanalize coronary chronic total occlusions (CTO) using controlled ablation inside the CTO. BACKGROUND The PlasmaWireTM System is a new bipolar radiofrequency (RF) wire system utilizing plasma-mediated ablation to facilitate wire crossing in CTOs. Two independent PlasmaWireTM wires are used in tandem for channel creation by applying RF energy between the tips so as to localize the ablation. METHODS Prospective, nonrandomized, single-arm, multicenter study in seven patients with CTOs indicated for percutaneous coronary intervention (PCI). RESULTS In this study, both wires were antegradely delivered to the distal end of CTO for antegrade re-entry in two cases and bidirectionally (antegrade and retrograde) delivered to the CTO for retrograde re-entry in five cases. In all cases, channel creation was achieved within a few seconds and was confirmed on angiogram or intravascular ultrasound (IVUS) and CTO recanalization was successfully achieved without any major adverse cardiac and cerebrovascular events (MACCE) or other minor complications. The clinical follow-up showed no clinical event at 1 month. CONCLUSIONS The PlasmaWireTM System was shown to be safe and effective in obtaining CTO recanalization through a re-entry channel utilizing plasma-mediated ablation while reducing procedure time. The PlasmaWire™ System is a new bi-polar RF wire system utilizing plasma-mediated ablation for channel creation to facilitate CTO recanalization. This first-in-human study in which seven patients were enrolled was conducted to demonstrate the safety, efficacy, and efficiency of this system for CTO recanalization. Channels through the CTOs were successfully created within a few seconds by applying RF energy between the tips of two independent PlasmaWireTM wires and recanalization was achieved in all cases without any complication. The PlasmaWireTM System may safely facilitate CTO recanalization with less vessel injury and improve initial results of CTO PCI while reducing procedure time.
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Affiliation(s)
- Daitaro Kanno
- Department of Cardiovascular Medicine, Sapporo Cardio Vascular Clinic, Sapporo, Japan
| | - Etsuo Tsuchikane
- Department of Cardiovascular Medicine, Toyohashi Heart Center, Toyohashi, Aichi, Japan
| | - Kenya Nasu
- Department of Cardiovascular Medicine, Toyohashi Heart Center, Toyohashi, Aichi, Japan
| | | | - Yoshifumi Kashima
- Department of Cardiovascular Medicine, Sapporo Cardio Vascular Clinic, Sapporo, Japan
| | - Umihiko Kaneko
- Department of Cardiovascular Medicine, Sapporo Cardio Vascular Clinic, Sapporo, Japan
| | - Tsutomu Fujita
- Department of Cardiovascular Medicine, Sapporo Cardio Vascular Clinic, Sapporo, Japan
| | - Yoriyasu Suzuki
- Department of Cardiovascular Medicine, Nagoya Heart Center, Nagoya, Aichi, Japan
| | - Takahiko Suzuki
- Department of Cardiovascular Medicine, Toyohashi Heart Center, Toyohashi, Aichi, Japan
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Liu JB, Goldberg BB. Catheter-based intraluminal sonography. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2004; 23:145-160. [PMID: 14992352 DOI: 10.7863/jum.2004.23.2.145] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
With the development of interventional and minimally invasive surgical techniques in the last decade, a strong interest in intraluminal sonography has arisen because of the need for better imaging information and management of the interventional procedure. High-resolution intraluminal sonography is a unique approach for the evaluation of a wide range of abnormalities within the luminal structures throughout the body. This imaging technique has been able to obtain information not available with even the most sophisticated percutaneous sonography, CT, or MRI. The uniqueness of this approach has led to extensive research, establishing a variety of clinical applications. These miniature catheter-based transducers have become important supplemental tools in the evaluation of the urinary and gastrointestinal tracts. Other areas need to be evaluated more thoroughly before efficacy is established, but the concept of using miniature transducers has shown promise in many areas of the body. This should lead to the provision of important information for decision making relative to patient care and surgical intervention. In the future, with projected technical progress, intraluminal sonography should substantially improve its diagnostic capabilities.
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Affiliation(s)
- Ji-Bin Liu
- Jefferson Ultrasound Research and Education Institute, Thomas Jefferson University Hospital, Jefferson Medical College, Philadelphia, Pennsylvania, USA
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3
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Maat LP, Slager CJ, van Herwerden LA, Schuurbiers JC, van Suylen RJ, Kofflard MJ, ten Cate FJ, Bos E. Spark erosion myectomy in hypertrophic obstructive cardiomyopathy. Ann Thorac Surg 1994; 58:536-40. [PMID: 8067859 DOI: 10.1016/0003-4975(94)92248-9] [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: 01/28/2023]
Abstract
The design features of the cutting electrode and the electrical characteristics of a monopolar electrosurgical device were specially adapted for performing a septal myectomy in patients with hypertrophic obstructive cardiomyopathy. Both the cutting behavior and electrode design were found to facilitate myectomy.
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Affiliation(s)
- L P Maat
- Department of Thoracic Surgery, Erasmus University Rotterdam, The Netherlands
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4
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Slager CJ, Schuurbiers JC, Oomen JA, Bom N. Electrical nerve and muscle stimulation by radio frequency surgery: role of direct current loops around the active electrode. IEEE Trans Biomed Eng 1993; 40:182-7. [PMID: 8319969 DOI: 10.1109/10.212058] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Tissue cutting by electrosurgery is often accompanied with stimulation of nerves and muscles, despite the high frequency of the alternating current being applied. The main source of this stimulation is thought to be the generation of low frequency current by the nonlinear sparking process. However, measurement of this low-frequency current, in the generator electrode's circuit, showed relatively small values, barely sufficient to support this hypothesis. In this study more powerful low frequency current could be identified, indeed also originating from the nonlinear sparking process. Local direct and low frequency currents, at a level of tens of milliamperes, appeared to be generated between different sites of the active electrode-tissue interface. Probably these local currents have not been noticed before as they cannot be detected in the outer chain of generator, electrodes, and connecting wires. This finding may explain why most measures, intended to prevent stimulation by modifying this outer chain, had only limited success.
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Affiliation(s)
- C J Slager
- University of Hospital of Rotterdam-Dijkzigt, The Netherlands
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5
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Reiber JHC, van der Zwet PMJ, Von Land CD, Koning G, Van Meurs B, Buis B, van Voorthuisen AE. Quantitative coronary arteriography: equipment and technical requirements. ACTA ACUST UNITED AC 1993. [DOI: 10.1007/978-94-011-1854-5_5] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
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Slager CJ, Phaff AC, Essed CE, Bom N, Schuurbiers JC, Serruys PW. Electrical impedance of layered atherosclerotic plaques on human aortas. IEEE Trans Biomed Eng 1992; 39:411-9. [PMID: 1592407 DOI: 10.1109/10.126614] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Electrical impedance measurements were performed on 13 atherosclerotic human aortic segments at 67 measuring spots in order to determine whether or not on the basis of these data a distinction can be made between atherosclerotic lesions and normal tissue. Stenosis localization and guidance of interventional techniques could be among the applications of an impedance measuring technique implemented on a catheter system. The experimental results, obtained with a two-electrode measuring technique, show that the apparent resistivity of an atherosclerotic spot does not necessarily deviate much from the resistivity of normal tissue. This is clarified by histology which shows that the majority of lesions has a surface layer of connective, fibrous tissue having almost similar conducting properties as the normal arterial wall. For gaining a deeper understanding of the way in which the measured data come about, a physical model of an atherosclerotic lesion is presented and confronted with the data. Both experimental data and theoretical considerations lead to the conclusion that only when the superficial fibrous layer is absent or very thin in relation to the size of the measuring electrode, the measured resistivity at a lesion is much higher than at normal spots. This occurs as a consequence of the high ohmic properties of the calcified or lipid deposits in the atherosclerotic lesion.
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Affiliation(s)
- C J Slager
- Thorax-center, University Hospital Rotterdam-Dijkzigt, The Netherlands
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7
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Crowley RJ, Hamm MA, Joshi SH, Lennox CD, Roberts GT. Ultrasound guided therapeutic catheters: recent developments and clinical results. INTERNATIONAL JOURNAL OF CARDIAC IMAGING 1991; 6:145-56. [PMID: 1833471 DOI: 10.1007/bf01797847] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The increasing use of intravascular ultrasound technology by clinicians is providing detailed and immediate information about the results of interventions, and this is stimulating the development of new catheters that use ultrasound imaging to control therapy in real time. Cold and thermal balloon angioplasty, atherectomy, embolectomy, laser ablation and rotational recanalization are a few of the interesting capabilities now being added to ultrasound catheters. We report on the development and characteristics of some of these devices and attempt to assess their potential to precisely direct therapy.
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Affiliation(s)
- R J Crowley
- Boston Scientific Corporation, Watertown, MA 02172
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8
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Oomen A, van Erven L, Vandenbroucke WV, Verdaasdonk RM, Slager CJ, Thomsen SL, Borst C. Early and late arterial healing response to catheter-induced laser, thermal, and mechanical wall damage in the rabbit. Lasers Surg Med 1990; 10:363-74. [PMID: 2144035 DOI: 10.1002/lsm.1900100410] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Pulsed lasers are being promoted for laser angioplasty because of their capacity to ablate obstructions without producing adjacent thermal tissue injury. The implicit assumption that thermal injury to the artery is to be avoided was tested. Thermal lesions were produced in the iliac arteries and aorta of normal rabbits by a) electrical spark erosion, b) the metal laser probe, and c) continuous wave neodymium-yttrium aluminum garnet (Nd-YAG) laser energy through the sapphire contact probe. High-energy doses were used to induce substantial damage without perforating the vessel wall. Thermal lesions (n = 77) were compared with mechanical lesions (n = 22) induced by oversized balloon dilation. Medial necrosis was induced by all four injury methods. Provided no extravascular contrast was observed after the injury, all damaged segments were patent after 1 to 56 days. The progression of healing with myointimal proliferation was remarkably similar for all injuries. At 56 days, the neointima measured up to 370 microns. In conclusion, provided no perforation with contrast extravasation occurred, the normal rabbit artery recovered well from transmural thermal injury. The wall healing response is largely nonspecific.
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Affiliation(s)
- A Oomen
- Interuniversity Cardiology Institute of The Netherlands
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9
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Gal D, Steg PG, Rongione AJ, DeJesus ST, Clarke RH, Isner JM. Vascular spasm complicates continuous wave but not pulsed laser irradiation. Am Heart J 1989; 118:934-41. [PMID: 2510488 DOI: 10.1016/0002-8703(89)90227-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Preliminary clinical experience with laser angioplasty has suggested that arterial spasm may complicate attempts to employ laser light to accomplish vascular recanalization. The present study was designed to investigate the role of energy profile on the development of arterial spasm during laser angioplasty. Laser irradiation was delivered percutaneously in vivo to New Zealand white rabbits and to Yucatan microswine with or without atherosclerotic lesions induced by a combination of balloon endothelial denudation and atherogenic diet. Continuous wave (CW) laser irradiation from an argon ion gas laser (wavelength 488 to 514 nm) was applied to 23 arteries, while 16 arteries were irradiated using a pulsed xenon chloride (308 nm) or xenon fluoride (351 nm) excimer laser. Arterial spasm, defined as greater than 50% reduction in luminal diameter narrowing, complicated delivery of laser light to 17 (74%) of the 23 arteries irradiated with the CW argon laser. Spasm was consistently observed at powers greater than 2 W, at cumulative exposures greater than 200 seconds, and at total energy greater than 200 joules. Spasm was typically diffuse (including the length of the vessel) and protracted (lasting up to 120 minutes). Intra-arterial nitroglycerin (up to 300 micrograms) produced only temporary and incomplete resolution of laser-induced spasm. In contrast, spasm was never observed in any of the 16 arteries in which laser angioplasty was performed using a pulsed laser (0.95 to 6.37 joules/cm2, 10 to 50 Hz, 48 to 370 seconds). Thus CW but not pulsed laser angioplasty may be complicated by arterial spasm.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- D Gal
- Department of Biomedical Research, St. Elizabeth's Hospital, Tufts University School of Medicine, Boston, MA
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Bom N, ten Hoff H, Lancée CT, Gussenhoven WJ, Bosch JG. Early and recent intraluminal ultrasound devices. INTERNATIONAL JOURNAL OF CARDIAC IMAGING 1989; 4:79-88. [PMID: 2671171 DOI: 10.1007/bf01745137] [Citation(s) in RCA: 96] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The history of intraluminal echography dates back to the very beginning of diagnostic ultrasound. Over the years many fascinating ideas and applications of catheter tip or gastroscopic tube tip mounted transducers have been described. This chapter surveys these methods, subdividing them into a) measurements; b) Doppler and c) imaging. The survey ranges from early work of Cieszynski on the feasibility of echocardiography to more recent intra-arterial catheter tip Doppler with guidewire and balloon as described by Serruys. Examples of ultrasound catheter tip echography in combination with other techniques such as angioscopy, laser ablation and spark erosion are also described. Today practical approaches are limited to imaging only. The three major approaches for catheter tip echo imaging are described and compared. This paper concludes with the results of automatic contour analysis of the inner arterial boundaries.
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Affiliation(s)
- N Bom
- Thoraxcentre, Erasmus University Rotterdam, the Netherlands
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11
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Borst C, Rienks R, Mali WP, van Erven L. Laser ablation and the need for intra-arterial imaging. INTERNATIONAL JOURNAL OF CARDIAC IMAGING 1989; 4:127-33. [PMID: 2527915 DOI: 10.1007/bf01745142] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
In 48 patients with severe claudication due to a total obstruction of the femoropopliteal artery, percutaneous recanalization was attempted with a 2.2 mm diameter rounded sapphire contact probe in conjunction with a continuous wave Nd:YAG laser. In eight patients the contact probe laser catheter took a subintimal course that could not be redressed. Laser recanalization needs high-resolution diagnostic information on the complex anatomy of the obstruction. Intra-arterial ultrasound imaging may provide the necessary information to evaluate, monitor or guide novel angioplasty techniques. The design of an ultrasound catheter which combines high-resolution diagnostic imaging with steerability, flexibility and controlled ablation is now the major engineering challenge in interventional cardiology.
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Affiliation(s)
- C Borst
- Department of Cardiology, Heart-Lung Institute, Utrecht, The Netherlands
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12
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Gussenhoven WJ, Essed CE, Frietman P, Mastik F, Lancée C, Slager C, Serruys P, Gerritsen P, Pieterman H, Bom N. Intravascular echographic assessment of vessel wall characteristics: a correlation with histology. INTERNATIONAL JOURNAL OF CARDIAC IMAGING 1989; 4:105-16. [PMID: 2527913 DOI: 10.1007/bf01745140] [Citation(s) in RCA: 103] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
In vivo application of intravascular high frequency ultrasonic imaging for peripheral and coronary artery disease is a promising technique for vascular surgeons, radiologists and cardiologists. This report demonstrates in vitro results obtained with a high frequency imaging catheter (40 MHz) in 70 human specimens including arteries with and without atherosclerosis, veins, coronary artery bypass grafts and vascular prosthetic material. Correlation between the ultrasonic images and the histologic characteristics of the corresponding vessel wall tissue and lumen geometry was established. In addition, the effect of intervention techniques i.e. balloon angioplasty, spark erosion and laser were studied with ultrasound and histology. It is anticipated that development of such a catheter imaging technique has potential for diagnostic imaging and for combination with therapeutic systems.
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Yamanashi WS, Yassa NA, Hill DL, Lewis JE, Patil AA, Lester PD. Electromagnetic field focusing probe (EFFP)--a new angioplasty tool. Angiology 1988; 39:1014-21. [PMID: 2973268 DOI: 10.1177/000331978803901202] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
An electromagnetic field focusing probe (EFFP) consists of a radiofrequency generator, solenoidal coil, and a hand-held or catheter probe. The probe is operated in the near field (distance within one wave length of an electromagnetic field source) of a coil, which induces eddy current in a biological tissue. The induced eddy current is converged maximally at the tip of the probe upon contact of the tip with the tissue. The probe produces very high temperatures depending on the wattage selected. In this study, the EFFP was used to evaporate atheromatous plaques in human cadaver abdominal aorta specimens, which were then studied histologically. Gas produced by this technique was analyzed and the volume found to be related to power delivered, but in such small amounts as to be of no embolic significance. While temperature varied with wattage and time of application, it was maximal at the probe tip and easily controlled, resulting in clean obliteration of plaque.
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Affiliation(s)
- W S Yamanashi
- City of Faith Medical and Research Center, Tulsa, Oklahoma
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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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Morphologic and densitometric quantitation of coronary stenoses; an overview of existing quantitation techniques. ACTA ACUST UNITED AC 1988. [DOI: 10.1007/978-94-009-1309-7_4] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
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Fleisher HL, Thompson BW, McCowan TC, Ferris EJ, Reifsteck JE, Barnes RW. Human percutaneous laser angioplasty. Patient selection criteria and early results. Am J Surg 1987; 154:666-70. [PMID: 2962520 DOI: 10.1016/0002-9610(87)90240-6] [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: 01/03/2023]
Abstract
Percutaneous transluminal laser angioplasty is a new method for treating atherosclerotic disease previously not amenable to routine percutaneous transluminal angioplasty techniques. Our results compared favorably with other clinical trials. Patient selection criteria include lesions in the superficial femoral or popliteal system not capable of being treated with routine percutaneous transluminal angioplasty. We think that these lesions include high-grade stenoses or short segmental occlusions. Heavily calcified vessels and long segment occlusions measuring greater than 12 cm in length are probably not amenable to percutaneous transluminal laser angioplasty. The long-term results of this form of therapy for peripheral vascular disease remain unknown.
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Affiliation(s)
- H L Fleisher
- Department of Surgery, University of Arkansas for Medical Sciences, Little Rock 72205
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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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