Percutaneous peripheral laser angioplasty with a pulsed Nd-YAG laser and sapphire tips
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Abstract
Percutaneous transluminal laser angioplasty with a pulsed Nd-YAG laser (1064 nm wavelength, 100μs pulse duration, up to 0.4 J per pulse, 10 Hz repetition rate) coupled to optical fibres with sapphire tips of 1.8 and 2.2 mm diameter was performed under experimental conditions and then in 30 chronic occlusions of femoral and popliteal arteries in 22 patients.
The experimental study in 11 human cadaverous arteries revealed that this laser system was effective in the recanalization of seven femoropopliteal occlusions, but the relative rigidity of the sapphire-tipped contact probe prevented its access to two infrapopliteal vessels. Two perforations occurred after the recanalization of 18 and 15 cm, respectively.
Clinically the procedure was successful in 17 out of 25 sessions (68%). The probe formed a primary channel of at least 2.0 mm width which was further dilated by conventional balloon catheter. Ankle/brachial systolic pressure index (ABPI) increased from 0.43±0.13 to 0.79±0.21 after the procedure. In eight cases complications occurred. Two reocclusions were treated by Streptokinase infusion, two procedures were repeated 2 months later, one patient was referred to elective bypass surgery, and three patients were treated conservatively. Six patients were followed-up for more than 6 months. In one patient claudication of 400 m reappeared. ABPI showed a moderate decrease from 0.84±0.20 to 0.69±0.19.
These first results are encouraging and it is likely that this method could become an important adjunct to balloon angioplasty.
Key words
Atherosclerosis Peripheral arteries Laser angioplasty Pulsed Nd-YAG laser Sapphire tipsPreview
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