Excimer Laser Coronary Angioplasty: American Experience with the AIS System

  • James R. Margolis
  • S. Mehta
  • AIS Registry Investigators

Abstract

Since Andreas Gruntzig’s first reported percutaneous dilatation of coronary arteries, in 1979 (1), a plethora of devices have been developed to perform nonsurgical dilatation of occluded and stenosed coronary arteries. Besides the wide availability of vastly improved PTCA equipment, various lasers, stents, atherectomy and angioscopy devices are broadening the applicability of interventional cardiology techniques (2–7). The new modalities may also be useful in avoiding some of the drawbacks of PTCA. Pathological and angioscopic examination of coronary arteries after even uncomplicated PTCA uniformly reveals a severely disrupted intimai surface (8–10). This intimal injury, an integral component of PTCA, may lead to early closure or late restenosis. PTCA is less successfully in long or calcified lesions, chronic total occlusions, ostial disease, diffusely diseased vessels and stenosed or occluded saphenous vein grafts (11). These limitations provided an impetus to develop technologies which could open coronary arteries without major intimai damage, and could deal effectively with coronary disease states where PTCA is impossible or less effective (12). Because laser coronary angioplasty actually removes atherosclerotic plaque, there are compelling theoretical reasons why it would be superior to PTCA for the treatment of complex lesions, and for the prevention of early abrupt closure and late restenosis (13–15).

Keywords

Burner Catheter Torque Argon Aspirin 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Gruntzig AR, Senning A, Siegenthaler WE (1979) Nonoperative dilatation of coronary artery stenosis: Percutaneous transluminal coronary angioplasty. New Engl J Med 301: 61PubMedCrossRefGoogle Scholar
  2. 2.
    Waller B (1989) Crackers, Breakers, Stretchers, Drillers, Scrapers, Shavers, Burners, Welders and Melters–The Future Treatment of Atherosclerotic Coronary Artery Disease? A Clinical-Morphologic Assessment. Am Coll Cardiology 1: 969–987CrossRefGoogle Scholar
  3. 3.
    Forrester JS, Litvack F, Grundfest W, Hickey A (1987) A per-spective of coronary disease seen through the arteries of living man. Circulation 75: 505–513PubMedCrossRefGoogle Scholar
  4. 4.
    Grundfest WS, Litvack F, Hickey A et al. (1987) The current status of angioscopy and laser angioplasty. J vast Surg 5: 667–673Google Scholar
  5. 5.
    Litvack F et al. (1989) Percutaneous Excimer Laser Coronary Angioplasty in Lesions Not Well Suited for PTCA. Circulation 80 (suppl II): II - 253Google Scholar
  6. 6.
    Sanborn TA, Bonan R, Cumberland DC, Faxon DP, Leachman R, Linnemeier Ti, Myler RK (1988) Percutaneous coronary laser-assisted balloon angioplasty with flexible, central lumen laser probe catheters (abtract). Circulation 78 (suppl II): II - 295CrossRefGoogle Scholar
  7. 7.
    White G (1989) History and development of cardiovascular endoscopy. In: White GH, White RA (eds.) Angioscopy: Vascular and coronary applications. Year Book Medical Publ, Chicago pp 20–36Google Scholar
  8. 8.
    Block PC, Myler RK, Stertzer S, Fallon JT (1981) Morphology after transluminal angioplasty in human beings. New Engl J Med 305: 382–385PubMedCrossRefGoogle Scholar
  9. 9.
    Waller BF (1987) Pathology of transluminal balloon angioplasty used in the treatment of coronary heart disease. Hum Path 18: 476–484PubMedCrossRefGoogle Scholar
  10. 10.
    Waller, BF (1983) Early and late morphologic changes in human coronary arteries after per-cutaneous transluminal coronary angioplasty. Clin Cardiol 6: 363–372PubMedCrossRefGoogle Scholar
  11. 11.
    Linnemeier RJ, Bonan R, Cumberland DC, Faxon DP, Leachman R, Myler RK, Sanborn TA (1988) Human percutaneous laser-assisted coronary angioplasty of saphenous vein bypass grafts: Early multicenter experience (abstract). Circulation 78 (suppl II): II - 295Google Scholar
  12. 12.
    Crea F, Davies G, McKenna W, Pashazade M, Taylor K, Maser A (1986) Percutaneous laser recanalization of coronary arteries. Lancet 1: 214–215CrossRefGoogle Scholar
  13. 13.
    Litvack F, Grundfest WS, Segalowitz J, Papoionanniou T, Goldenberg T, Laudenslager J, Hestrin L, Forrester JS, Sigler N, Cook S (1990) Interventional cardiovascular therapy by laser and thermal angioplasty. Circulation 81 (suppl IV): IV-109-IV-116Google Scholar
  14. 14.
    Litvack F et al. (1988) Role of Laser and Thermal Ablation Devices in the Treatment of Vascular Diseases. AM J Cardiol 61: 81G - 86GPubMedCrossRefGoogle Scholar
  15. 15.
    Eldar M (1989) Laser angioplasty: a review. Review Article: 68 REFS. Isr J Med Sci 25: 222–228PubMedGoogle Scholar
  16. 16.
    Schaldach M (1990) Cardiovascular laser application. Review Article: 30 REFS. Artif Orsans 14: 28–40CrossRefGoogle Scholar
  17. 17.
    Boulnais JL (1986) Photophysical processes in recent medical laser developments: A review. Lasers Med Sci 1: 47–66CrossRefGoogle Scholar
  18. 18.
    Cote G (1989) Catheter systems for laser angioplasty. In: Abela GS (ed.) Lasers in cardiovascular medicine and surgery: Fundamentals and techniques. Kluwer, Norwell, MAGoogle Scholar
  19. 19.
    Steg G, Rongione AJ, Gal D, DeJesus ST, Clarke RH, Isner JM (1988) Contrasting effects of continuous wave versus pulsed laser irradiation on vascular smooth muscle (abtract). Lasers Surg Med 8: 152Google Scholar
  20. 20.
    Avrillier S, Ollivier JP, Gandjbakhch I, Delettre E, Bussiere JL (1990) XeCI excimer laser coronary angioplasty: a convergence of favourable factors. Review Article: 24 REFS. J Photochem Photobiol B 6 (1–2): 249–257PubMedCrossRefGoogle Scholar
  21. 21.
    Grundfest WS, Segalowitz J, Goldenberg T et al. (1990) The Effect of Fiber Optic Delivery System Geometry, Power Desity and Energy on Excimer Laser Luminal Recanalization. Circulation 82 (suppl IV): III - 495Google Scholar
  22. 22.
    Abela GS, Normann S, Cohen D, Feldman RL, Geiser EA, Conti CR (1982) Effects of carbon dioxide, Nd-YAG, and argon laser radiation on coronary atheromatous plaques. Amer J Cardiol 50: 1199–1205Google Scholar
  23. 23.
    Grundfest WS, Litvack F, Forrester JS et al. (1985) “Laser Ablation of Human Atherosclerotic Plaque Without Adjacent Tissue Injury.” AM J Cardiol 53: 929–933Google Scholar
  24. 24.
    Litvack F et al. (1987) Comparison of Acute and Chronic Effects of Argon and excimer Laser Energy on Canine Aorta. J Am Coll Cardiol: 178AGoogle Scholar
  25. 25.
    Diethrich EB, Hanafy HM, Santiago OJ, Bahadir I, Kiesslins JJ, Stern LA (1990) Intraoperative coronary excimer laser angioplasty: Preliminary Clinical Experience. Angiology 41 (9 Pt 2): 777–784PubMedGoogle Scholar
  26. 26.
    Litvack F, Eisler NL, Margolis JR, Grundfest WS, Rothbaum D, Linnemeier T, Hestrin LB, Tsoi D, Cook SL, Krauthamer D et al. (1990) Percutaneous excimer laser coronary angioplasty. Am J Cardiol 66 (15): 1027–1032PubMedCrossRefGoogle Scholar
  27. 27.
    Ollivier JP, Gandjbakhch I, Avrillier S, Delettre E, Bussiere JL, Cabrol C (1990) Intraoperative coronary artery endarterectomy with excimer laser. J Thorac Cardiovasc Sur 100 (4): 606–611Google Scholar
  28. 28.
    Hickey A et al. (1989) Arterial Color Flow Duplex Sonography of the Lower Extremities Before and After Excimer Laser Angioplasty. J Am Coll Cardiol Vol 13: 149AGoogle Scholar
  29. 29.
    Sanborn TA, Alexopoulos D, Marmur JD, Kahn H, Badimon JJ, Badimon L, Fuster V (1990) Coronary excimer laser angioplasty: reduced complications and indium-111 platelet accumulation compared with thermal laser angioplasty. J Am Coll Cardiol 16: 502–506PubMedCrossRefGoogle Scholar
  30. 30.
    Laudenslager Jet al. (1989) Design Considerations for a Clinical XeCl Excimer Laser Angioplasty System. SPIE 1066: 252–254CrossRefGoogle Scholar
  31. 31.
    Litvack F et al. (1988) Pulsed Laser Angioplasty: Wavelength Power and Energy Dependencies Relevant to Clinical Application. Lasers in Surgery and Medicine 8: 60–65PubMedCrossRefGoogle Scholar
  32. 32.
    Goldenberg T et al. (1989) Percutaneous Excimer Laser Angioplasty in Humans. Proxeedings of the Society of Photo-Optical Instrumentation Engineers. SPIE 1067, January 1989Google Scholar
  33. 33.
    Grundfest WS, Litvack F, Goldenberg T et al. (1985) Pulsed Ultraviolet Lasers and the Potential for Safe Laser Angioplasty. Am J Surg 150: 220–226PubMedCrossRefGoogle Scholar
  34. 34.
    Laudenslager J et al. (1986) Effect of 308 nm Laser Pulse Duration on Fiber-optic Transmission and Biologic Tissure Ablation. Proc CLEO Paper TUA2, San Francisco, CAGoogle Scholar
  35. 35.
    Bresnahan DR, Bresnahan JF et al. (1990) Excimer Laser Coronary Angioplasty: Single Center Experience in Patients with anatomy suitable for Coronary Balloon Angioplasty. Circulation 82 (suppl III): III - 672Google Scholar
  36. 36.
    Ghazzal ZMB, Hearn JA, Goldenberg T et al. (1990) Outcome Predictors after Excimer Laser: Detailed Multicenter Angiographic Analysis. Circulation 82 (suppl III): III - 670Google Scholar
  37. 37.
    Cook S et al. Percutaneous Excimer Laser coronary Angioplasty of Lesions Not Favorable for Balloon Angioplasty. Division of Cardiology, Dept. of Medicine, Cedars-Sinai Medical CenterGoogle Scholar
  38. 38.
    Karsch KR, Haase KK, Mauser M, Ickrath O, Voelker W, Duda S, Seipel L (1989) Percutaneous coronary excimer laser angioplasty: initial clinical results. Lancet 16; 2 (8664): 647–650Google Scholar
  39. 39.
    Eigler N et al. (1990) Excimer Laser Angioplasty of Ostial Coronary Stenosis: Results of Multicenter Study. Circulation 82 (suppl III): III - 1Google Scholar
  40. 40.
    Raizner A, Litvack F, Goldenberg T et al. (1990) Improved Results in Patients with Long Coronary Stenoses Using Excimer Laser Angioplasty. Circulation 82 (suppl III): III - 671Google Scholar
  41. 41.
    Reeer GS, Bresnahan JF, Bresnahan DR (1990) Excimer Laser Coronary Angioplasty (ELCA) in Patients with Restenosis after Prior Balloon Angioplasty (BA). Circulation 82 ((suppl III): III - 672Google Scholar
  42. 42.
    Levine S, Mehta S, Krauthamer D, Margolis RJ (1991) Excimer Laser Coronary Angioplasty of Clacified Lesions. Abstract Am Coll Cardiology, 40th Annual Scientific Session, 1991Google Scholar
  43. 43.
    Litvack F, Grundfest WS, Goldenberg T, Laudenslager J, Forrester JS (1989) Percutaneous excimer laser angioplasty of aortocoronary saphenous vein grafts. J Am Coll Cardiol 14 (3): 803–808PubMedCrossRefGoogle Scholar
  44. 44.
    Litvack F, Grundfest W, Eisler N, Tsoi D, Goldenberg T, Laudenslager J, Forrester J (1989) Percutaneous excimer laser coronary angioplasty (letter). Lancet 8; 2 (8654): 102Google Scholar
  45. 45.
    Untereker W, Litvack F, Margolis J et al. (1990) Excimer Laser Coronary Angioplasty of Saphenous Vein Grafts. Circulation 82 (suppl III): III - 680Google Scholar
  46. 46.
    Cook S, Eigler N et al. (1990) Angiographic Determinants of Successful Excimer Laser Coronary angioplasty. Circulation 82 (suppl III): III - 671Google Scholar
  47. 47.
    Karsch KR, Haase KK, Voelker W, Baumbach A, Mauser M, Seipel L (1990) Percutaneous coronary excimer laser angioplasty in patients with stable and unstable angina pectoris. Acute results and incidence of restenosis during 6-month follow-up. Comments in: Circulation: 2018–2021; Circulation 81: 1849–1859Google Scholar
  48. 48.
    Karsch KR, Haase KK, Mauser M, Voelker W (1989) Initial angiographic results in ablation of atherosclerotic plaque by percutaneous coronary excimer laser angioplasty without subsequent balloon dilation. Am J Cardiol 64 (19): 1253–1257PubMedCrossRefGoogle Scholar
  49. 49.
    Kaltenbach M, Vallbracht C, Kober G (1987) Long Wire Technique: experience with 100 procedures. Z Kardiol 76 (suppl 6): 53–57PubMedGoogle Scholar
  50. 50.
    Gregory KW, Walsh AA, Schomacker KT, Kochevar IE (1990) Excimer Laer Energy Absorbed by Radiographic Contrast Media Results in Cytotoxic Photoproducts. Circulation 82 (suppl III)Google Scholar
  51. 51.
    Grundfest W. Personal CommunicationGoogle Scholar
  52. 52.
    Margolis JR, Litvack F, Krauthamer D, Trautwein R, Goldenberg T, Grundfest W (1990) Excimer laser coronary angioplasty: American multicenter experience. Herz 15: 223–232Google Scholar
  53. 53.
    Trautwein R, Margolis J et al. (1990) Excimer Laser Coronary Angioplasty of Chronic Total Occlusions. Circulation 82 (suppl III): III - 687Google Scholar
  54. 54.
    Litvack F et al. (1989) Complications During Excimer Laser Angioplasty are Similar to Those During PTCA. Circulation 80 (suppl II): II - 254Google Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 1991

Authors and Affiliations

  • James R. Margolis
    • 2
    • 1
  • S. Mehta
    • 1
  • AIS Registry Investigators
    • 1
  1. 1.Cardiovascular LaboratorySouth Miami HospitalMiamiUSA
  2. 2.Cardiovascular LaboratorySouth Miami HospitalMiamiUSA

Personalised recommendations