Intracoronary ultrasound following excimer-laser angioplasty. An in-vitro study in human coronary arteries.

Abstract

To study the ablation effects induced by excimer laser coronary angioplasty (ELCA), we examined 41 segments of nine isolated coronary arteries. An electronic intracoronary ultrasound device (ICUS: 20 MHz, 3.5F, Endosonics) was positioned coaxially within the vessel. Angioplasty was performed using a 1.7 mm ELCA catheter (Spectranetics) which was placed in the lumen and directed vertically onto the intimal surface of the vessel (fluence: 10-50 mJ.mm-2). The laser catheter was removed after each lasing cycle to allow the stepwise evaluation of the morphological effects of ELCA and to avoid reaching the adventitia. Ultrasound images were compared with the corresponding histological specimens. In all cases, the ablation site could be correctly identified by ICUS. No penetration of the adventitia was seen at histology. Ablation depth was 0.31 +/- 0.18 mm as determined by histology and 0.34 +/- 0.18 mm as determined by ultrasound; the diameter of the crater was 0.63 +/- 0.21 mm, and 0.75 +/- 0.16 mm, respectively, and wall thickness was 0.68 +/- 0.18 mm, and 0.83 +/- 0.20 mm, respectively. A statistical relationship between ultrasonic and histology measurements was only found, however, for assessment of wall thickness (r = 0.71). The identification of small ablation effects by ICUS was possible with great accuracy and ELCA could be performed without penetration of the adventitial layers. However, exact quantification of the crater dimensions was not possible due to limitations of the axial and lateral resolution. Thus, for the guidance of ELCA by ICUS a further improvement in the resolution capabilities of ICUS devices is mandatory.