Laser radiation has specific attributes: monochromaticity, high coherence and polarization. These properties result in the extensive use of lasers in medicine. Laser devices can be assigned into three basic groups by means of their level of energy: high, medium and low energy. All of these types of radiation are used in medicine. However, the most commonly used, in basic science and clinical studies, is low-energy radiation. Molecular effects of low energy laser irradiation on cells are generally described as "fotobiostimulation" and "fotobiomodulation". These phenomena consequently lead to attempts to exploit this kind of radiation as a treatment method (low-level laser therapy-LLLT). Areas in which LLLT is used are: regenerative medicine (for healing wounds and ulcers); aesthetic medicine (to improve appearance of scars); dentistry (to accelerate healing of implants); physiotherapy (to reduce chronic pain syndromes), orthopedics (in bone healing) and cardiology (as a prevention of restenosis after percutaneous coronary intervention). This paper discusses the medical applications of LLLT which are used in daily clinical practice as well as those The laser was invented by Theodor Maiman in 1960 and since that time it is used in many different aspects of human life, including medicine. Lasers are distinguished from other light sources by their coherence, polarization and monochromaticity; therefore, they can transmit a wide range of energy.The physical process enabling the laser to function is called stimulated emission (laser is an acronym of light amplification by stimulated emission of radiation). There are many ways to classify laser devices. Lasers can be grouped by gain medium, wavelengths, modes of operation but the most useful way, from a medical point of view, is the division by energy level. And so by the amount of energy transmitted, the sources of laser radiation are divided into 3 basic groups: low, medium and high energy.There are many reports regarding the usefulness of full laser energy spectrum in clinical practice. High-energy radiation causes tissue destruction and therefore it is mainly applied in surgery. It is used for coagulation, cutting tissue, control of bleeding, destruction of tumors etc. Medium energy lasers are mainly used in oncology, especially as a part of photodynamic therapy. The low energy laser, among the all energy radiation groups, seems to have the widest range of applications in medicine. Despite much research, the exact mechanism action of low energy laser radiation on the human body is still unknown. Due to numerous studies on low-energy radiation, new therapeutic applications are being discovered and enrolled to clinical practice. The aim of this paper is to review the most common clinical applications of low-energy lasers.

The effect of low-level laser therapy (LLLT) on the cardiovascular system is not fully established. Since the endothelium is an important endocrine element, establishing the mechanisms of LLLT action is an important issue.The aim of the study was to evaluate the effect of transdermal LLLT on endothelial function.In this study, healthy volunteers (n = 40, age = 20–40 years) were enrolled. N = 30 (14 female, 16 male, mean age 30 ± 5 years) constituted the laser-irradiated group (LG). The remaining 10 subjects (6 women, 4 men, mean age 28 ± 5 years) constituted the control group (CG). Participants were subjected to LLLT once a day for three consecutive days. Blood for biochemical assessments was drawn before the first irradiation and 24 h after the last session. In the LG, transdermal illumination of radial artery was conducted (a semiconductor laser λ = 808 nm, irradiation 50 mW, energy density 1.6 W/cm2 and a dose 20 J/day, a total dose of 60 J). Biochemical parameters (reflecting angiogenesis: vascular endothelial growth factor (VEGF), fibroblast growth factor (FGF), angiostatin; antioxidative status: glutathione (GSH) and the nitric oxide metabolic pathway: symmetric dimethylarginine (SDMA), asymmetric dimethylarginine (ADMA) and l-arginine) were assessed. In the LG, a significant increase in GSH levels and considerable decrease in angiostatin concentration following the LLLT were observed. No significant differences in levels of the VEGF, FGF, SDMA, ADMA were observed.LLLT modifies vascular endothelial function by increasing its antioxidant and angiogenic potential. We found no significant differences in levels of the nitric oxide pathway metabolites within 24 h following the LLLT irradiation.

Shock Waves (SW) are acoustic disturbances that propagate through a medium carrying the energy. These specific sonic pulses are composed of two phases—high positive pressure, a rise time < 10 ns, and a tensile wave. Originally Shock Waveswereintroduced to clinical practice as a part of the lithotripsy therapy focused on disrupting calcific deposits in the body. Since that time, shock wave therapy (SWT) has gone far beyond the original application related to the destruction of kidney stones. In this narrative Review, we present basic clinical applications of the SWT along with the potential therapeutic application in clinical practice.

Aim The goal of the study is to develop a model allowing to investigate precisely the effect of low-level laser therapy (LLLT) on platelet aggregation and to verify the hypothesis regarding the role of the nitric oxide (NO) bioavailability and platelet activation markers in modulating platelet aggregation. Methods A total of 41 healthy volunteers at the age of 21–45 years were investigated. At first, platelet aggregation in response to three agonists (TRAP, ADP, and collagen) was evaluated following previous exposure to different doses of laser radiation (λ = 662 nm) to assess the dose-response effect. Subsequently, plasma levels of platelet activation markers (PF4—platelet factor-4 and sP-selectin) as well as the substrate for nitric oxide synthase, L-arginine, and its competitive inhibitors (ADMA—asymmetric dimethylarginine and SDMA—symmetric dimethylarginine) were measured. Results All doses of laser irradiation significantly reduced the aggregation. However, the most pronounced effect was observed for 19.7 J/cm2. No significant differences in the levels of platelet activation markers nor in the nitric-oxide-metabolic-pathway compounds between analyzed groups were noted. Conclusions We have demonstrated in the established in vitro experimental model that the LLLT in a reproducible manner decreases the whole blood platelet aggregation regardless of the NO bioavailability or changes in the platelet activation markers.

Background: Diabetes mellitus (DM) is one of the major risk factors contributing to Acute Coronary Syndromes (ACS) and is associated with an increased risk of adverse clinical outcomes following percutaneous coronary intervention (PCI), even when the second generation of drug-eluting stents (DES) is used. In order to overcome the disadvantages of permanent caging of a vessel with metallic DES, bioresorbable scaffold (BRS) technology has been recently developed. However, the prognosis of patients with DM and ACS treated with PCI via subsequent implantation of Magmaris (Biotronik, Berlin, Germany)—a novel magnesium-bioresorbable scaffold—is poorly investigated. Methods: A total of 193 consecutive subjects with non-ST elevation acute coronary syndrome (NSTE-ACS) who, from October 2016 to March 2020, received one or more Magmaris scaffolds were enrolled in this study. The diabetic group was compared with non-diabetic subjects. Results: There were no significant differences in the occurrence of primary endpoints (cardiovascular death, myocardial infarction, and in-stent thrombosis) and principal secondary endpoints (target-lesion failure, scaffold restenosis, death from any reason, and other cardiovascular events) between the two compared groups in a 1-year follow-up period. Conclusions: The early 1-year-outcome of magnesium bioresorbable scaffold (Magmaris) seems to be favorable and suggests that this novel BRS is safe and effective in subjects with NSTE-ACS and co-existing DM.

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Introduction: Left main (LM) disease is associated with a large myocardial ischemic territory. Calcification with co-existing undilatable lesions is a predictor of poor clinical outcomes following LM percutaneous coronary interventions (PCI).Aim: To evaluate the safety and efficiency of shockwave intravascular lithotripsy (S-IVL) in highly calcified LM diseases.Material and methods: The study population consisted of sixteen patients qualified for PCI -mainly males (81.3%) with coronary artery disease (CAD) treated with left main S-IVL PCI due to unsuccessful attempts of plaque modification with a non-compliant (NC) balloon catheter, or rotational devices. Clinical success was defined as effective stent delivery and deployment (with less than < 20% in-stent residual stenosis) with preserved coronary flow TIMI-3 (Thrombolysis in Myocardial Infarction) at the end of the procedure.Results: The most frequent indication for PCI was acute coronary syndrome (ACS) (62.5%). In these high-risk (average Syntax score 24) patients, clinical success of PCI was achieved in 100% of cases. In the short-term observation, we recorded two major adverse cardiac and cerebrovascular events (MACCE) including one fatal, acute stent thrombosis.Conclusions: Our data suggest that the use of S-IVL is safe and effective as a bail-out strategy to manage LM lesions resistant to high-pressure NC balloon inflation. Despite encouraging initial results, future large studies with long-term observation are required to evaluate the safety and efficacy of S-IVL in LM stenosis.

Heavy calcification remains one of the greatest challenges in the treatment of coronary artery disease (CAD), especially in subjects with an acute coronary syndrome (ACS). In the present case series study of high-risk patients with ACS, including both STEMI and NSTEMI, we performed a rota-lithotripsy—a combination of rotational atherectomy with subsequent intravascular lithotripsy—as a novel bail-out strategy to facilitate stent delivery in a tortuous calcified coronary artery.