A Route to Laser Angioplasty in the Presence of Fluoroscopy Contrast Media, Using a Nanosecond-Pulsed 355-nm Laser

Herzog, Amir; Steinberg, Idan; Gaisenberg, Elad; Nomberg, Reut; Ishaaya, Amiel A.

doi:10.1109/jstqe.2015.2487889

Cited by 14 publications

(18 citation statements)

References 14 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Four catheter sizes (2.35 mm with off center alignment, 2.0, 1.5, and 0.9 mm) are available for treatment of FP and tibial arteries; the larger two catheters have an aspiration feature to limit procedural embolization. The system has approximately threefold higher affinity for atheroma than for endothelium and is indifferent to the presence of contrast material . The currently commercial B‐Laser™ system and catheters line are shown in Figures and , respectively.…”

Section: Methodsmentioning

confidence: 99%

Novel laser‐based catheter for peripheral atherectomy: 6‐month results from the Eximo Medical B‐Laser™ IDE study

Rundback

Chandra²,

Brodmann

et al. 2019

Cathet Cardio Intervent

View full text Add to dashboard Cite

Background The B‐Laser™ atherectomy system (Eximo Medical, Israel) is a 355 nm solid‐state Nd:YAG short pulse laser for de‐novo and restenotic infrainguinal PAD with enhanced affinity for atheroma and calcified plaque. Methods The study was a prospective, single‐arm, multi‐center, international, open‐label study assessing the B‐Laser™ in symptomatic (Rutherford 2 to 4) infrainguinal peripheral artery disease. Primary core lab efficacy was mean reduction in diameter stenosis >20% by the B‐Laser™ catheter alone. Cardiovascular death, major amputation, target lesion revascularization, WIQ, ABI and Rutherford class were obtained at baseline and out to 6 months. Duplex ultrasound patency (PSVR <2.5), was evaluated by Core Lab. Results 97 (77 in USA) PAD subjects (51 male, mean 70.5 years [range 46–86]) with 107 lesions were treated with B‐Laser™ (average length 5.4 cm [range 1–24], 29.0% infrapopliteal. 77.6% calcification [26.2% severe], 21.5% chronic total occlusions, 20.6% re‐stenotic). Average reduction in residual stenosis post B‐Laser™ alone was 33.6 ± 14.2%. Baseline and final stenosis (post laser and adjunctive therapy) were 85.7 ± 12.2% and 17.7 ± 11.0%, respectively. Duplex patency was 96.8% at 30‐days and 85.6% at 6 months (95.7% 6‐month patency with severe calcification), and did not differ between POBA vs. DCB sub‐groups. ABI, Rutherford category and WIQ all improved. There was one MAE and three TLRs out of 101 lesions. No procedural distal embolization was noted and there were no major device‐related dissections. Conclusions Experience with the B‐Laser™ atherectomy system in infrainguinal PAD procedures demonstrates a high level of safety and efficacy for denovo and restenotic infrainguinal arterial lesions.

show abstract

Section: Methodsmentioning

confidence: 99%

Novel laser‐based catheter for peripheral atherectomy: 6‐month results from the Eximo Medical B‐Laser™ IDE study

Rundback

Chandra²,

Brodmann

et al. 2019

Cathet Cardio Intervent

View full text Add to dashboard Cite

show abstract

“…Additional experimental work that is related to this work and was used as a background to this study can be found in Refs. . Specifically, Ref.…”

Section: Methodsmentioning

confidence: 99%

“…Recently, a solid‐state laser at a wavelength of 355 nm (third harmonic of Nd : YAG) was suggested to be applied in the treatment of thrombotic lesions, atherectomy and cardiac lead extraction . Within the latter two, unique characteristics, such as selective ablation of the fibrotic lesion and eliminating the necessity of flushing the fluoroscopy contrast media prior to the laser operation, were demonstrated.…”

Section: Introductionmentioning

confidence: 99%

Atherectomy using a solid‐state laser at 355 nm wavelength

Herzog

Oszkinis

Planer

et al. 2017

Journal of Biophotonics

Self Cite

View full text Add to dashboard Cite

Peripheral arterial disease (PAD), caused by atherosclerotic processes, is allied with an increased risk of ischemic events, limb loss, and death. Recently, the use of a solid-state laser at 355 nm within a hybrid catheter was suggested for that purpose. In this work, short nanosecond pulses of a solid-state laser at 355 nm delivered through a hybrid catheter, composed of optical fibers and a blunt mechanical blade, are used to conduct a pre-clinical study and two clinical cases. The pre-clinical study consisted of an atherosclerotic calcified cadaveric leg and a porcine in vivo trial within the iliac artery, respectively. The clinical cases include chronic total occlusions with a calcified lesion. The occluded cadaveric leg is recanalized successfully and no evidence of thermal necrosis is indicated in the histopathology analysis of the porcine study. No arterial wall damage is demonstrated on the animals' treated arteries and no significant impact on blood count and biochemistry analysis is noted in the animal trial. Successful recanalization of the occluded arteries followed by balloon angioplasty is obtained in both clinical cases. Our work constitutes a proof of concept for using a solid-state pulsed laser at 355 nm in atherectomy.

show abstract

“…The main motivation for the use of this tissue is related to the fact that employing the 355 nm wavelength has been proposed for cardiovascular procedures that involve interactions within a blood vessel (e.g. laser assisted lead extraction, laser atherectomy ). Furthermore, its smooth and homogenic intima layer facilitates gross pathology.…”

Section: Methodsmentioning

confidence: 99%

“…One of the foremost lasers commonly used in these procedures is the excimer XeCl gas laser, which emits radiation at a wavelength of 308 nm and has a typical pulse duration of a few hundreds of nanoseconds . Recently, the employment of an alternative solid‐state laser at a wavelength of 355 nm (third harmonic of Nd : YAG) was proposed in laser‐angioplasty, in the treatment of thrombotic stroke and in cardiac lead‐extraction . These recent findings could not have been discovered without the ability to deliver sufficient fluence of pulsed 355 nm through optical fibers to ablate biological tissue.…”

Section: Introductionmentioning

confidence: 99%

Shaping photomechanical effects in tissue ablation using 355 nm laser pulses

Herzog

Steinberg

Ishaaya

2016

Journal of Biophotonics

Self Cite

View full text Add to dashboard Cite

We investigate the influence of the cladding diameter of an optical delivery fiber on the ablation dynamics of porcine aorta immersed in tetracycline antibiotic solution using 355 nm nanosecond pulses. We manipulate the pressure transients by enforcing a rear rigid interface (applied by an enlargement of the cladding diameter) to the ablated area, which leads to enhanced ablation efficiency along with a reduction in tissue disruption effects. Numerical simulations, based on the finite elements method, are used to study the propagation of the pressure transients within the suggested scheme. Ultrasonic transducers are used for measuring the increased pressure in front of the fiber's facet and the reduced pressure at the fiber's circumference in the presence of large diameter cladding. The increase and decrease are both found to be by a factor of ˜1.8. The width of the cavitation bubble is measured by high-speed photography. An enlargement of 13.8% is demonstrated, at the expense of backward expansion along the fiber's axis. A histopathological in vitro study demonstrates an average enhancement of 12.27% in the diameter of the ablated crater, as well as significant reduction in the disruption effects. Our study sheds light on the potential to improve the ablation efficiency without additional energy cost, along with attaining improved safety for interventional medical procedures.

show abstract

A Route to Laser Angioplasty in the Presence of Fluoroscopy Contrast Media, Using a Nanosecond-Pulsed 355-nm Laser

Cited by 14 publications

References 14 publications

Novel laser‐based catheter for peripheral atherectomy: 6‐month results from the Eximo Medical B‐Laser™ IDE study

Novel laser‐based catheter for peripheral atherectomy: 6‐month results from the Eximo Medical B‐Laser™ IDE study

Atherectomy using a solid‐state laser at 355 nm wavelength

Shaping photomechanical effects in tissue ablation using 355 nm laser pulses

Contact Info

Product

Resources

About