Peripheral percutaneous transluminal laser angioplasty in humans: In vitro investigations and clinical results with a novel laser catheter system

Abstract

Summary: Percutaneous transluminal laser angioplasty has become an accepted method of treatment of peripheral arterial occlusive disease. To minimize the risk of arterial wall perforation during laser angioplasty, a novel laser catheter system was developed. In 113 obliterated postmortem human arteries the perforation rate was 0.9%. The mean degree of stenosis was reduced from 89 i-9 % before, to 53 -f 11 % after laser irradiation. Clinical Nd:YAG laser angioplasty was performed in 19 patients suffering from peripheral arterial occlusive disease. The Fontaine stage improved in 16 patients; in no case did it deteriorate. The mean degree of stenosis was reduced by laser angioplasty from 9 1 & 12 % to 3 1 * 19 % . A further reduction down to 13 k 18 % was achieved by subsequent percutaneous transluminal balloon angioplasty . The systolic Doppler ankle-arm pressure gradient was improved from 0.58k0.26 to 0.89k0.25. In 7 patients microemholisms were detectable on the final angiogm . There was no acute reocclusion and no perforation. Within a followup period of 12 months, four restenoses were diagnosed by digital subtraction angiography. On average, the Doppler index was 0.75k0.32.