A multi-center trial of laser ballon angioplasty for abrupt closure following PTCA

Jj, Ferguson; Dear, W.E.; Leatherman, Louis L.; Safian, Robert D.; King, Susan; Douglas, John S.; Spears, Jenna

doi:10.1016/0735-1097(90)91820-k

Cited by 19 publications

(3 citation statements)

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“…The reports of laser angioplasty to date involve small numbers of patients with variable angiographic follonup. The reported restenosis mte for EXCIhIEIi laser varies from 39 to 78% [83,84]. Similar findings were reported in a small study by Schnwtz and colleagues [84,85], in which patients \\.ere randomized to laser balloon ringioplasty (LBA) or balloon dilation.…”

Section: Patient-related Variables Several Reports [ 56-59]supporting

confidence: 55%

Coronary Restenosis after Angioplasty

Bailey

1993

J Intensive Care Med

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Section: Patient-related Variables Several Reports [ 56-59]supporting

confidence: 55%

Coronary Restenosis after Angioplasty

Bailey

1993

J Intensive Care Med

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“…The sealed, smoothened vascular surface may result in decreased platelet accumulation and therefore in less restenosis. This laser system has been used percutaneously for coronary angioplasty in humans, with satisfactory acute results 121, specially in the treatment of abrupt closure following angioplasty [ 3 ] . However, the restenosis rate has not been shown to be diminished compared to conventional balloon angioplasty [4,5].…”

Section: Words: Laser Balloon Angioplasty Laser Energy Rabbits Athmentioning

confidence: 99%

Acute biological response to laser balloon angioplasty in the atherosclerotic rabbit

et al. 1994

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Laser balloon angioplasty with Nd:YAG energy has been proposed as a method to seal intimal dissection and prevent elastic recoil after balloon angioplasty. To better define the vessel response to laser balloon angioplasty, its effects on luminal diameter, Indium-111 labelled platelet deposition, and histology were studied in 10 atherosclerotic rabbits. Balloon angioplasty was performed in both iliac arteries and was followed by laser balloon angioplasty in only one iliac artery. The nonlased artery served as a control. Single (15-35 W for 20 sec) or repetitive laser pulses (12-25 W for 20 sec x 3) were used. Platelet deposition was quantified 2 hr after the intervention. Lumen diameter (mm) increased following balloon angioplasty from 0.99 +/- 0.47 (mean +/- SD) to 1.92 +/- 0.43 and 0.89 +/- 0.46 to 1.99 +/- 0.57 in the balloon and laser-treated arteries, respectively (P < 0.001 for both groups for comparisons to baseline, P = NS for between groups comparison). Laser balloon angioplasty resulted in a further increase in luminal diameter to 2.42 +/- 0.53 (P < 0.02) when compared to the post balloon angioplasty diameter. Platelet deposition (10(6)/cm vessel) was higher following laser balloon angioplasty (26.9, 10.2-189; median range) than after balloon angioplasty (10.6, 3.4-30), P < 0.001. Histologic evidence of laser "sealing" was present in only one artery. Thus although laser balloon angioplasty results in an improved lumen diameter, it is accompanied by increased platelet deposition. In the atherosclerotic rabbit model, abolition of vascular recoil rather than "sealing" seems to be the most important advantage of laser balloon angioplasty over conventional balloon angioplasty.

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“…It is a reasonably trackable device that retains the safety of the "over the wire" balloon angioplasty systems. It appears to be efficacious in a growing series of patients treated for acute closure syndromes [99,101]. Any beneficial effect on long-term restenosis rates remains to be determined.…”

Section: Laser Balloon Angioplastymentioning

confidence: 99%

New technologies for the treatment of obstructive arterial disease

Fischell

Stadius

1991

Cathet. Cardiovasc. Diagn.

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The well-known limitations of balloon angioplasty include unpredictable abrupt closure, chronic total occlusion, diffuse disease, and restenosis, among other factors. These limitations have prompted the development of new technologic approaches to angioplasty including laser applications for plaque ablation, mechanical device applications for plaque removal/debridement, and stent devices for structural maintenance of vascular lumen patency. Devices which directly apply laser energy for ablation of plaque material include a balloon-centered laser angioplasty system, excimer laser ablation catheter systems, and a fluorescence-guided spectral feedback laser system. Experience with these devices indicates that plaque can be successfully ablated by using laser energy. Vessel perforation and dissection are complications reported with these devices and the effects of laser angioplasty on restenosis remain unclear. Indirect application of laser energy has been tested by using a "hot tip" catheter and a laser balloon angioplasty system. Although the hot tip device has received FDA approval for use in peripheral arteries, it appears to have very limited applications in the coronary arteries. Laser balloon angioplasty appears to be beneficial in the setting of threatened acute closure; the device continues to be evaluated for potential beneficial impact on restenosis. Mechanical atherectomy catheters are designed to remove atherosclerotic plaque from the arterial system and include the AtheroCath, the Transluminal Extraction Catheter (TEC), and the Pullback Atherectomy Catheter (PAC). The Rotablator is an atheroablation device which debrides the obstructing plaque material with distal embolization of the particulate debris. Successful removal/debridement of atherosclerotic plaque has been demonstrated with the AtheroCath, Rotablator, and the TEC device. Pre-clinical studies demonstrate successful removal of plaque material with the PAC device. Despite the theoretic advantage of removing plaque material when performing angioplasty with these devices, there has been little or no reduction in restenosis rates based on a significant experience with the AtheroCath and the Rotablator. Intravascular stent devices including one self-expanding device design and two balloon-expandable device designs have been employed successfully in the elective setting to treat recurrent restenosis lesions. Two of the devices have been successfully tested in the setting of threatened acute closure. Early follow-up studies suggest some improvement in restenosis rates in certain clinical settings following intravascular stenting. Acute and subacute thrombosis remain substantial problems for stent devices and very aggressive anticoagulation regimens are necessary to minimize the adverse events. In summary, a number of a new technologic approaches for treatment of atherosclerotic lesions have been developed and are undergoing significant clinical evaluation.(ABSTRACT TRUNCATED AT 400 WORDS)

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A multi-center trial of laser ballon angioplasty for abrupt closure following PTCA

Cited by 19 publications

References 0 publications

Coronary Restenosis after Angioplasty

Coronary Restenosis after Angioplasty

Acute biological response to laser balloon angioplasty in the atherosclerotic rabbit

New technologies for the treatment of obstructive arterial disease

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