Laser Uses in Noncoronary Arterial Disease

Jayet, Jérémie; Coscas, Raphaël; Heim, Frédéric; Goëau-Brissonnière, Olivier; Javerliat, Isabelle; Chakfé, Nabil; Coggia, Marc

doi:10.1016/j.avsg.2018.06.010

Cited by 10 publications

(4 citation statements)

References 45 publications

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“…However, subsequent device iterations improved efficacy and reduced complications associated with its use by delivering greater amounts of energy but with lower heat and bubble generation 8,9 . Additionally, improved understanding of ELCA parameters and the growing experience with peripheral use of laser renewed the interest of the interventional cardiology community and led to an increase in the use of ELCA albeit in a niche setting 10,11 …”

Section: Introductionmentioning

confidence: 99%

Excimer laser coronary atherectomy during complex PCI: An analysis of 1,471 laser cases from the British Cardiovascular Intervention Society database

Protty

Hussain

Gallagher

et al. 2020

Cathet Cardio Intervent

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Introduction Excimer laser coronary atherectomy (ELCA) is a recognized adjunctive therapy utilized in the percutaneous management of complex coronary lesions. Studies examining its safety and utility have been limited by small sample sizes. Our study examines the determinants and outcomes of ELCA. Methods Using the British Cardiac Intervention Society database, data were analyzed on all PCI procedures in the UK between 2006–2016. Descriptive statistics and multivariate logistic regressions were used to examine baseline, procedural and outcome associations with ELCA. Results We identified 1,471 (0.21%) ELCA cases out of 686,358 PCI procedures. Baseline covariates associated with ELCA use were age, BMI, number of lesions, CTO or restenosis attempted and history of prior MI, CABG or PCI. Procedural co‐variates associated with ELCA were the use of glycoprotein inhibitors, intravascular imaging, rotational atherectomy, cutting balloons, microcatheters and intra‐aortic balloon pumps. Adjusted rates of in‐hospital major adverse cardiac/cerebrovascular events (MACCE) or its individual components (death, peri‐procedural MI, stroke and major bleed) were not significantly altered by the use of ELCA. However, there were higher odds of dissection (OR 1.52, 95% CI 1.17–1.98), perforation (OR 2.18, 95% CI 1.44–3.30), slow flow (OR: 1.67, 95% CI 1.18–2.36), reintervention (OR: 2.12, 95% CI 1.14–3.93) and arterial complications (OR: 1.63, 95% CI 1.21–2.21). Conclusions ELCA use during complex PCI is associated with higher risk baseline and procedural characteristics. Although increased rates of acute procedural complications were observed, ELCA does not increase likelihood of in‐hospital MACCE or its individual components.

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Section: Introductionmentioning

confidence: 99%

Excimer laser coronary atherectomy during complex PCI: An analysis of 1,471 laser cases from the British Cardiovascular Intervention Society database

Protty

Hussain

Gallagher

et al. 2020

Cathet Cardio Intervent

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“…As a true step forward in the endovascular treatment of occlusive disease ( 22 ), excimer laser angioplasty nowadays is commonly used in the field of peripheral artery disease (atherosclerotic plaques) and has shown a satisfied outcome with a mean follow-up of 15 ± 7 months. The primary patency was 65% ± 20% and the mean distal embolism rate during the procedure was 5% ( 23 ). But excimer laser alone couldn't finish the angioplasty without balloons, and for a chronic white fibrous thrombus the excimer laser was not effective.…”

Section: Discussionmentioning

confidence: 99%

A novel integrated angioscope-laser system for atherosclerotic carotid artery occlusion: Feasibility and techniques

Zhang

2022

Front. Surg.

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IntroductionAtherosclerotic extracranial carotid artery stenosis accounts for about 20%–30% of all strokes, which is one of the leading causes of adult morbidity and mortality. Although carotid endarterectomy (CEA) is still the mainly operational manner for atherosclerotic carotid artery stenosis/occlusion (ACAS/ACAO), and carotid angioplasty and stenting (CAS) have been used as an alternative, both CEA and CAS have limitations of their own, such as extensive invasiveness and in-stent restenosis.MethodsIn this study we established a novel interventional system in vitro to take advantage of both CEA and CAS. Twenty consecutive carotid atherosclerotic plaques were harvested from the patients who underwent CEA. The plaques were randomized into two groups and inserted into the pruned and sutured descending aortas of the swine in vitro. The ZebraScope™ was modified with a protective device on its flexible tip, so that the plaque could be dissected from the wall of parent carotid artery and ablated completely without damage to the carotid artery. The holmium:YAG (Ho:YAG) and thulium fiber laser (TFL) generators were alternately used when needed.ResultsAll the carotid atherosclerotic plaques were completely ablated by Ho:YAG laser and/or TFL. The Ho:YAG laser was more effective for the atherosclerotic plaques with severe calcification, while the TFL was more suitable for those with moderate calcification. There were still some thermal injury spots on the inner wall of the parent carotid artery caused by the laser in the non-protected group B. In the protected group A, on the contrary, there was no even a thermal injury spot was found on the relevant location except for one sample. The difference of ablating duration was statistically significant between group A (36.5 ± 4.79 min) and group B (63.4 ± 6.55 min) (P < 0.01).ConclusionAccording to our knowledge, this is the first attempt to ablate carotid atherosclerotic plaques assisted by the ZebraScope™ in vitro. The protective and dissecting device on the tip of the angioscope makes it safe and visible when the ablation is performed to carotid atherosclerotic plaques. The Ho:YAG laser and TFL are effective and safe for ablating the plaque in vitro.

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“…Finally, the accumulated materials are destroyed. This process, also named as photo ablation, leads to dissolution and vaporization of the atherosclerotic plaque [142][143][144]. Different sharp cutting devices are also used to remove plaques from arterial walls in directional (DA), rotational (RA) and Orbital atherectomy (OA) methods [145][146][147][148].…”

Section: Discussionmentioning

confidence: 99%

Targeting Atherosclerotic Plaque in Avicenna’s View

Yakhchali¹,

Vaghasloo²,

Ardakani³

et al. 2020

JICOA

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Objective: Cardiovascular disease (CVD) including atherosclerosis is currently the most common cause of death in the world. Atherosclerosis can be treated by a vast variety of modalities: from lifestyle modification to invasive open surgical bypass procedures. Regarding the limitations of conventional medicine, worldwide attention to complementary and alternative medicines has increased because of their holistic approach, lower cost and better public access. In this move towards Integrative Medicine -besides other traditional schools of medicine-Persian Medicine (PM) with its long historical background should be considered as a suitable source for research. Method: In this study we investigated major traditional literature of PM, Avicenna’s “Al-Qanun fi al-Tibb” [The Canon of medicine], to find suitable treatment modalities of atherosclerosis in comparison to conventional methods. Result: In the quest for a concept close to atherosclerosis, “sodde” (meaning obstruction) seems to be equal to atherosclerosis and “Mofattehaat” as opener drugs with different types including “Mohallelaat” (dissolvers) and “Moghatteaat” (cutting agents) have been recommended to remove the obstructing materials. Recent studies indicate that many of the medicinal herbs which were introduced as opener drugs by Avicenna have potential pharmacological effects on managing atherosclerosis. Conclusion: Scientific evidence confirm the efficacy of traditional herbs for elimination of atheroma. Antiobstructive traditional medicines are similar to the conventional atherectomy in targeting atheroma by removing atherosclerotic plaque directly, but they are non-invasive, user-friendly, much cheaper and probably with less side effects.

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Laser Uses in Noncoronary Arterial Disease

Cited by 10 publications

References 45 publications

Excimer laser coronary atherectomy during complex PCI: An analysis of 1,471 laser cases from the British Cardiovascular Intervention Society database

Excimer laser coronary atherectomy during complex PCI: An analysis of 1,471 laser cases from the British Cardiovascular Intervention Society database

A novel integrated angioscope-laser system for atherosclerotic carotid artery occlusion: Feasibility and techniques

Targeting Atherosclerotic Plaque in Avicenna’s View

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