Laser recanalization using metal capped fibers occurs by thermal vaporization of occluding plaque. However, little is known about the effects of blood and flow on the temperature of the laser probe or the arterial wall during lasing. To study this, probe and arterial wall temperatures were measured while a metal capped fiber, activated by an argon laser, was held stationary in a stenotic human peripheral artery. Arteries were perfused with saline and blood, and flow was varied from 0 to 140 cc/min. Probe temperatures were significantly higher in blood than in saline. However, the increased probe temperature achieved in blood was not transferred to the arterial wall. Increasing flow decreased probe temperature in both media, but again arterial wall temperatures were minimally affected. Thus, the presence of blood and flow may significantly affect heat generation and heat transfer during arterial recanalization using metal capped fibers.

Blood may limit laser ablation of arterial plaque by decreasing thermal energy transfer from metal-capped probes to arterial occlusions. Since a gas is a good insulator of heat, CO2 may be a better medium for laser recanalization. To study this possibility, a metal-capped fiber was positioned in a segment of blood-filled polyethylene tubing and activated with an argon laser. Probe temperatures were measured in blood and as the blood was displaced by flowing CO2 gas. Probe temperatures were higher at all powers studied in CO2 gas than in blood. Maximum probe temperatures averaged 518 +/- 24 degrees C after CO2 infusion versus 320 +/- 7 degrees C in blood, (P less than 0.0001). Blood aggregate formation was noted on the probe surface in blood but not in CO2 medium. Thus CO2 gas may be a preferable medium for laser recanalization, since higher probe temperatures are achieved, and the probe surface remains free of insulating blood coagulate.

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