Current problems of excimer laser angioplasty

Summary

Pulsed submicrosecond excimer laser irradiation provides the potential for debulking atherosclerotic material without significant thermal injury to the adjacent vessel wall. Considerable progress has been made during the last few years as to the quality of the optical fibers, the design of laser-fiber coupling devices and catheter systems, and, in particular, the development of long-pulse excimer lasers. With these improvements in technology, excimer laser angioplasty has become technically feasible, but most patients require subsequent balloon angioplasty to obtain an adequate final result. There are a number of major impediments to the clinical use of the excimer laser for angioplasty. Among those are problems relating to (1) the heterogenous ablative characteristics of plaque, (2) the potential mismatch between the open lumen of the vessel and the amount of atherosclerotic material that can be removed by the laser, and (3) the failure of the cutting tip of the catheter to engage in excentric lesions. These issues need resolution before excimer laser angioplasty can become an alternative to balloon angioplasty. Minor points include the distal embolization of the particulate debris and the thrombogenicity of the lased vascular surfaces.