Solid-state mid-infrared laser facilitated coronary angioplasty: Clinical and quantitative coronary angiographic results in 112 patients

Topaz, On; Rozenbaum, Eliezer A.; Schumacher, Audrey; Luxenberg, Michael G.

doi:10.1002/(sici)1096-9101(1996)19:3<260::aid-lsm2>3.0.co;2-q

Cited by 19 publications

(7 citation statements)

References 35 publications

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“…Laser are devices which emit electromagnetic energy which, upon absorption within the atherosclerotic plaques, can debulk the target tissue [1,2]. In cardiovascular medicine lasers are mainly used for revascularization of stenosed coronary arteries and saphenous vein grafts in patients with symptomatic coronary disease [3].…”

Section: Introductionmentioning

confidence: 99%

Excimer laser in acute myocardial infarction: Single centre experience on 66 patients

Ambrosini

Cioppa

Salemme

et al. 2008

International Journal of Cardiology

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Section: Introductionmentioning

confidence: 99%

Excimer laser in acute myocardial infarction: Single centre experience on 66 patients

Ambrosini

Cioppa

Salemme

et al. 2008

International Journal of Cardiology

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“…This causes breaking of thrombus with subsequent distal embolization and, consequently, acute myocardial infarction. In contrast, mid-infrared laser successfully dissolves coronary thrombi, as reported recently in a clinical study comparing 66 patients who had 74 thrombotic lesions to 46 patients with 55 thrombus-free stenoses [38].…”

Section: Clinical Laser Thrombolysismentioning

confidence: 69%

Holmium laser?induced coronary thrombolysis

Topaz

1996

J Thromb Thrombol

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~Dne role of thrombosis in acute myocardial infarction and unstable ischemic coronary syndromes is well documented [1][2][3]. Revascularization of thrombotic, occluded coronary vessels can be achieved by pharmacologic therapy [4,5], balloon angioplasty [6], transluminal extractional catheter [7], low-frequency ultrasound [8], and coronary artery bypass surgery [9]. Recently, lasers have been introduced as a means of optical thrombolysis [10,11]. Most clinical and basic research data on the application of lasers in this setting is based on in vivo and in vitro studies conducted with an investigational, pulsed-wave, mid-infrared holmium: YAG system. This editorial focuses on current status of holmium laser application for coronary thrombolysis. Means of ThrombolysisNumerous randomized clinical trials have established the advantages of thrombolytic therapy for patients with acute myocardial infarction [5]. Benefits include reduction of mortality [12][13][14][15][16][17][18], limitation of infarct size [19], improvement of left ventricular function [20], and increased patency of the infarct-related vessel [21] when compared with patients with acute infarction not treated with thrombolytic drugs. Despite its merits, pharmacologic therapy achieves vessel patency in only 75% of patients, does not dissolve the underlying atherosclerotic plaque, and can be associated with bleeding complications [5,13,14]. Altogether, pharmacologic thrombolytic therapy remains underutilized, and a large number of patients do not receive it [22][23][24], either because of delayed presentation after the onset of chest pain, age limitations, history of significant hypertension, or lack of inclusive electrocardiographic criteria. Notably, the value of thrombolytic agents is time dependent, with maximal benefit achieved in patients presenting up to 6 hours after the onset of symptoms. The effect of late thrombolysis, that is, treatment beginning more than 6 hours after symptom onset, remains controversial. The LATE study suggested that the time window for thrombolysis with intravenous rtPA should be extended to at least 12 hours [25]. On the other hand, when compared with controls, those presenting later than 12 hours after the onset of chest pain exhibit an excess number of deaths during the first postinfarction day attributed to thrombolytic agents [26].Mechanical reperfusion is a viable alternative to pharmacologic therapy in patients presenting either too late or with contraindications to drug treatment. Infarct-related vessel patency is achieved in more than 90% of patients who undergo balloon angioplasty in this setting [27][28][29]. However, in the presence of a large thrombus, results are oftentimes suboptimal due to distal embolization and incomplete removal of the entire clot, creating the need for intracoronary injection of thrombolytic drugs; hence, the rationale for application of advanced interventional devices, such as laser. Generally, cardiovascular lasers have the potential to selectively ablate atheromatous, coronary plaques ...

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“…The excimer's shallow in-plaque penetration necessitates direct contact with the thrombotic plaque, leading to trauma and embolization. The mid-infrared laser has been successful in the treatment of thrombotic lesions [15][16][17][18], and especially in patients sustaining acute myocardial infarction who present with large thrombus burden resistant to thrombolytic drugs [19][20][21]. Nevertheless, despite the potential advantages and reported clinical success of this laser, Fig.…”

Section: Mid-infrared Laser-thrombus Interactionmentioning

confidence: 99%

“…Among the most common causes of laser-induced coronary perforations are forced lasing, using unrecommended fluences, attempting multiple passes through an already dissected lesion, oversizing of catheter and breaching of recommended indications [34]. From the experience of the excimer laser investigators [35], as well as from the present experience, many perforations can be managed locally, and over time, with increasing operator experience, the frequency of coronary artery perforation significantly declines [15,35].…”

Section: Safety and Complicationsmentioning

confidence: 99%

Acute results, complications, and effect of lesion characteristics on outcome with the solid‐state, pulsed‐wave, mid‐infrared laser angioplasty system: Final multicenter registry report

et al. 1998

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Background and Objective:The solid-state, mid-infrared holmium:YAG laser (2.1 m wavelength) is a relatively new percutaneous device that has recently been evaluated in a multicenter study. Because of its unique wavelength and photoacoustic effects on atherosclerotic plaques, this laser may be useful in treatment of symptomatic patients with coronary artery disease. This study sought to evaluate the safety and efficacy of mid-infrared laser angioplasty in the treatment of coronary artery lesions. occurred in 2.2% of patients; major dissection in 5.8% of patients, and spasm in 12% of patients. No predictor of major complications was identified. Six-month angiographic restenosis was documented in 54% of patients, and clinical restenosis occurred in 34% of patients. Conclusion: Mid-infrared laser has a safety profile similar to that of other debulking devices. This laser may be useful in select patients presenting with acute ischemic syndromes associated with intracoronary thrombus; however, like other coronary lasers, it is limited by the need for adjunctive balloon angioplasty and/or stenting to achieve adequate final luminal diameter. No beneficial effects on reducing 6-month restenosis rates were observed. Patients and Methods

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Solid-state mid-infrared laser facilitated coronary angioplasty: Clinical and quantitative coronary angiographic results in 112 patients

Cited by 19 publications

References 35 publications

Excimer laser in acute myocardial infarction: Single centre experience on 66 patients

Excimer laser in acute myocardial infarction: Single centre experience on 66 patients

Holmium laser?induced coronary thrombolysis

Acute results, complications, and effect of lesion characteristics on outcome with the solid‐state, pulsed‐wave, mid‐infrared laser angioplasty system: Final multicenter registry report

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