Laser probe ablation of normal and atherosclerotic human aorta in vitro: a first thermographic and histologic analysis.

Abstract

The metal-tipped optical fiber or "laser probe" has been extensively studied in animal preparations in vivo and in human clinical trials of revascularization. The aim of this study was to evaluate the thermal characteristics of laser probe tissue ablation and to contrast the vascular tissue response to exposure to the laser probe and bare optical fiber. A 2 mm laser probe was heated with up to 4 W of argon-ion laser irradiation and applied to six postmortem strips ofhuman nonatherosclerotic aorta as well as to five atherosclerotic aortic specimens. Surface temperature maps of the laser probe and of the vascular tissue in air were obtained via 8 to 12 ,um thermographic imaging. Laser probe temperature was additionally monitored via thermocouples. Two strips each of normal and diseased aorta were irradiated directly with the bare optical fiber. Thus a total of 43 laser probe application sites and 19 bare fiberoptic laser irradiation sites on a total of 15 aortic strips were analyzed both thermographically and histologically. Based on measured temperature rises and histologic findings, the following observations were made: (1) The laser probe heats initially at its tip and attains a uniform surface temperature distribution within 5 sec. The steady-state temperature attained by the probe is inversely related to the thermal conductivity of the surrounding media. In all media studied, probe temperature increases linearly with applied laser energy. (2) Tissue ablation starts at temperatures greater than 1000 C, and ablation temperatures typically exceed 1800 C. Adventitial temperatures during laser probe application may reach 700 C. Tissue ablation is enhanced both by greater laser energy deposition in the probe and by higher force at which the probe is applied to tissue. (3) Ablation of fibrofatty atheromata is more extensive than of nonatherosclerotic aortic tissue. This may be due to the lower thermal conductivity of atheromatous tissue. (4) In contrast to direct argon-ion laser ablation of aortic tissue, laser probe-mediated ablation occurs in a controlled fashion, is not associated with extensive subintimal dissections, and allows uniform conduction of heat to tissue as reflected by essentially "isothermal" injury lines. Circulation 76, No. 5, 1353No. 5, -1363No. 5, , 1987 ATHEROSCLEROTIC arterial occlusive disease continues to constitute the major cause of morbidity and mortality in the United States. Over the past 4 years, substantial work has been done in an attempt to develop a laser technology that can be applied to the percutaneous revascularization of obstructive peripheral vascular and coronary artery disease. In contrast to conFrom the Biomedical Engineering Program of the

Laser angioplasty. What has been learned from experimental studies and clinical trials?

“…Recent elegant in vitro thermographic studies of normal and diseased human aorta do provide some insight into the mechanism of action of one laser recanalization device, the laser probe. 10 In this study, it was found that the laser thermal probe was more effective in ablating fibrofatty plaque than nonatherosclerotic aorta. It was postulated that lower thermal conductivity and difflsivity constants of fibrofatty plaque relative to normal vessel wall were responsible for more extensive heating and evaporation of plaque.…”

“…10 The authors postulate on the basis of their histological observations that compression of residual cellular and tissue components results in a decrease in the vacuolated cellular space. Thus, heat and pressure appear to be two important mechanisms of the "contact" laser approach to atherosclerotic lesions.…”

Effects of blood flow on laser probe temperature in human arteries

“…The results reported here suggest that laser probe temperatures of this level can be attained in blood but not in saline (using argon laser energy and aluminum tipped fibers). Other investigators have reported higher energy requirements for plaque ablation in saline [13,19,20], and Welch et al [21] have reported that lower laser probe temperatures are achieved in water than in blood for the same amount of energy input. This apparent decreased efficiency of probe heat generation and thermal ablation in saline can possibly be explained by the fact that saline will remain at 100°C until water is vaporized [3,22].…”

Sapphire and metal tip recanalisation: Implications for safety

“…The characteristics of this device are determined by its surface temperature. There are many parameters which may influence this temperature such as : input power, probe mass, exposure time, environment, contact xvith tissue, probe motion and flow (20,21).…”

“…Despite the large number of patients treated in peripheral vessels, the working mechanism of the metal laser probe is not well understood (20,21). In order to measure the temperature of the probe a thermocouple was installed in a coaxial channel.…”