<title>Experimental and clinical evaluation of a spectroscopy system for fluorescence-guided excimer laser angioplasty</title>

Abstract

This study evaluated a single-laser approach for simultaneous ablation and fluorescence excitation for spectroscopic guidance of laser angioplasty. A spectroscopy system was developed and coupled to a clinical XeCl excimer laser. Ablation of 162 human aortic samples in saline and blood with 45 mJ/mm<SUP>2</SUP> per pulse yielded 676 fluorescence spectra validated histologically. Five types of spectra could be differentiated: atheroma, fibrous plaque, calcified lesion in saline, normal media and calcified lesion in blood. Discriminant analysis prospectively classified 576 validation spectra with a sensitivity between 83.5 and 100 percent and a specificity between 96.8 and 100 percent. Subsequently, the equipment was used in 16 patients for angioplasty of 18 coronary stenoses applying 500 to 1725 pulses with 45 to 60 mJ/mm<SUP>2</SUP> under saline flushing. A total of 783 spectra were recorded and validated by intracoronary ultrasound. Except for the media spectrum, all types of spectra were observed in vivo, too. The predominant sonographic category also prevailed in spectroscopy. In conclusion, using an excimer laser for angioplasty allows combining ablation and fluorescence excitation without a diagnostic laser. Principal types of atherosclerotic lesions and the media can be differentiated spectroscopically with this approach.