Efficacy of carbon monoxide laser in selectively intimal thermal welding--implications for laser balloon angioplasty.

Abstract

Excessive vascular damage causes excessive vascular repair, which results in restenosis. To limit the thickness of the coagulation layer in laser balloon angioplasty, we used a carbon monoxide (CO) laser, which has high tissue absorption, as a therapy laser source instead of a Nd: YAG laser. To investigate the benefit of short-penetration CO laser light to vascular tissue, excised human abdominal aorta was irradiated with a CO laser through a 30 microns polyethylene membrane. The temperature of the vascular tissue was continuously monitored during irradiation. CO laser irradiation of 20 W/cm2 was performed in either a continuous mode or an intermittent mode with various duty ratios (exposure/interval duration). With a total fluence of 200 J/cm2, the adventitial temperature decreased as the duty ratio was reduced. The adventitial temperature at a duty ratio of 1:2 was 43 degrees C. Microscopic examination of aorta which had been intermittently irradiated duty ratio of 1:2 showed thermal coagulation localized within the intima and a flattened intimal surface. These results suggest that intermittent laser irradiation with a CO laser can be used to limit the depth of thermal coagulation, and can selectively weld the intima without excessive thermal damage. Laser balloon angioplasty using a CO laser may help to prevent restenosis.