760-1 The Precision Guided Directional Laser Atherectomy Catheter: A New Approach to Percutaneous Coronary Revascularisation

Abstract

Directional coronary atherectomy has been shown to be a successful method of percutaneous coronary revascularisation, particularly in large vessels with eccentric stenoses. The application of laser technology to coronary revascularisation has not been as successful, mainly because of a relatively high rate of vessel wall perforation. We describe a combination endovascular imaging/laser atherectomy catheter (Precision Guided Directional Laser Atherectomy Catheter, PGDLAC) that may overcome these shortcomings by allowing precision guided intervention. The catheter consists of a laser cutting device with an integrated imaging system (fiberoptic or ultrasound). Fiberoptic imaging allows exact positioning and orientation of the laser tipped catheter within the vessel lumen, and visual control of plaque excision. In the second step, the vessel wall morphology is demonstrated using ultrasound, and the result of the intervention assessed without removing the catheter. Excised plaque fragments are extracted by way of the catheter, Preliminary results of in vitro experimental application of this device in human coronary arteries is promising and confirms the technical feasibility. Such a device potentially offers the advantages of effective, precision guided atherectomy in plaques of variable constitution, with a potential reduction in procedure time and radiation dose. By combining state of the art imaging and interventional technology, we have developed a precision guided directional laser atherectomy system that may provide more effective percutaneous coronary revascularisation than previously developed techniques.