The excimer laser: Gross, light microscopic and ultrastructural analysis of potential advantages for use in laser therapy of cardiovascular disease

Isner, Jeffrey M.; Donaldson, Roberta Fortin; Deckelbaum, Lawrence I.; Clarke, Richard H.; Laliberte, Sylvie M.; Ucciz, Angelo A.; Salem, Deeb N.; Konstam, Marvin A.

doi:10.1016/s0735-1097(85)80316-8

Cited by 193 publications

(35 citation statements)

References 16 publications

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“…There were 10 men and 13 women with a mean age of 67 years. A 308 nm excimer laser with an over-the-wire catheter (19) or balloon-centered end-on catheter (7) was used followed by balloon angioplasty. Twenty-four procedures were performed percutaneously, and two were performed with the vessel open in the operating room.…”

mentioning

confidence: 99%

Excimer laser—assisted femoral angioplasty: Early results

McCarthy¹,

Vogelzang²,

Nemcek³

et al. 1991

Journal of Vascular Surgery

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mentioning

confidence: 99%

Excimer laser—assisted femoral angioplasty: Early results

McCarthy¹,

Vogelzang²,

Nemcek³

et al. 1991

Journal of Vascular Surgery

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“…The irradiated vessel wall sections were examined for laser-specific alterations such as carbonization, perforation, dissection, and fragmentation of the internal elastic lamina.8,11 [23][24][25][26][27][28] The technique of immunohistological examination has been described previously16 '17 …”

Section: Application Of Brdumentioning

confidence: 99%

Vascular injury and time course of smooth muscle cell proliferation after experimental holmium laser angioplasty.

et al. 1992

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BACKGROUND In vitro experiments have shown that holmium laser energy can effectively ablate even calcified plaque in human arterial vessels. Because high-energy densities from holmium lasers can easily be transmitted through quartz fibers, this solid-state laser has been suggested as an alternative intraluminal treatment of atherosclerotic plaque. METHODS AND RESULTS To develop an intimal plaque, 35 New Zealand White rabbits underwent electrical stimulation of their right carotid artery for 28 days. Subsequently, in 25 rabbits, holmium laser angioplasty (wavelength, 2.12 microns; pulse duration, 150 microseconds; energy density, 350 mJ/mm2) was performed. To study the morphological results, the vessels were excised after 7, 14, 28, and 42 days. Cross sections were analyzed in regard to laser-specific injury. Staining of alpha-actin was used to identify smooth muscle cells (SMCs). After bromodeoxyuridine labeling, the extent of proliferation (number of cells undergoing DNA synthesis) was determined by using a monoclonal antibody. Holmium laser ablation resulted in an initial decrease of the numbers of intimal cell layers in the early group (7 days after treatment: 5 +/- 1 cell layers with 76 +/- 39 microns; control: 13 +/- 3 cell layers with 144 +/- 44 microns). Quantification of SMCs undergoing DNA synthesis in the intima (control: 51 +/- 19 cells/mm2) showed a significant increase of labeled cells after 7 (216 +/- 74 cells/mm2, p = 0.003) and 14 days (281 +/- 139 cells/mm2, p = 0.011). Integrity of the internal elastic lamina was disrupted in all animals after intervention. Seven and 14 days after treatment, a considerable reduction of medial cell nuclei was found in 10 of 12 animals. SMC proliferation in the medial layer was increased within the first 2 weeks after laser ablation (168 +/- 113 cells/mm2; control: 8 +/- 4 cells/mm2; p = 0.023). Six weeks after holmium laser angioplasty, SMC proliferation had returned to control levels in the intima and remained increased in the medial layer. This proliferative response resulted in a significant increase of intimal thickening within 6 weeks after laser ablation (30 +/- 6 cell layers, 375 +/- 97 microns resp.; p = 0.001 each). CONCLUSIONS Holmium laser treatment leads to considerable vessel wall injury and results in SMC proliferation in the intimal and medial layer with a maximum of proliferative activity within the first 2 weeks. Subsequently, this results in considerable intimal and medial hyperplasia within 6 weeks after treatment.

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“…Laser angioplasty removes the arterial occlusion either by vaporization or by photochemical disruption of molecular bonds [1][2][3][4], thus providing a significant the oretical advantage over balloon angioplasty [5][6][7], How ever, attempts to vaporize the tissue target using laser energy transmitted through an optical fiber from a re mote source have frequently been complicated by perfo ration of the arterial wall [8][9][10][11] due, in part, to poor spatial localization of the fiber tip. Moreover, laser an …”

Section: Introductionmentioning

confidence: 99%

High Frequency Ultrasound Guidance for Laser Angioplasty

Geschwind¹,

Kern²,

Labovitz³

et al. 1989

Am J Noninvas Cardiol

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Spatial relationships of a laser catheter and vascular anatomy to facilitate laser angioplasty were studied with high frequency ultrasonography in three models: (a) in vitro; (b) in vivo (rabbits), and (c) transcutaneously in humans. The in vitro model consisted of obstructed human cadaver femoral arteries embedded in agar and perfused with diluted blood. The animal model utilized the aortas of 8 anesthetized atherosclerotic rabbits. In these models, the laser delivery system consisted of a 0.2-mm optical fiber connected to a continuous wave neodymium yttrium aluminum garnet laser inserted into an infusion catheter which was advanced through a balloon-tipped guiding catheter to achieve variable coaxial intra-arterial positions. In humans, the laser catheter system alone without laser emissions was inserted percutaneously and imaged by ultrasound in the contralateral femoral artery of patients following coronary arteriography. Ultrasonographic dimensions of in vitro targets and laser created tunnels in these targets correlated with anatomic measurements (r = 0.82 and 0.72, respectively). In vitro and in vivo arterial wall perforations could be recognized and predicted when the fiber tip was positioned eccentrically close to the arterial wall. In 16 patients, the axial position of the balloon and laser catheters could be visualized. Precise definition of lumen surface structure was inadequate. Varying positions of the laser catheter within the artery were recognized in all 3 models. Although ultrasonography cannot presently be applied for all percutaneous transluminal angioplasty approaches, the current study supports the use of developing high frequency ultrasonic guidance for vascular laser systems.

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The excimer laser: Gross, light microscopic and ultrastructural analysis of potential advantages for use in laser therapy of cardiovascular disease

Cited by 193 publications

References 16 publications

Excimer laser—assisted femoral angioplasty: Early results

Excimer laser—assisted femoral angioplasty: Early results

Vascular injury and time course of smooth muscle cell proliferation after experimental holmium laser angioplasty.

High Frequency Ultrasound Guidance for Laser Angioplasty

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