Treatment of Subacute and Chronic Thrombotic Occlusions of the Lower Extremity Peripheral Arteries: The Role of Excimer Laser

Abstract

Subacute and chronic thrombi are frequently present in patients with symptomatic peripheral arterial disease and their presence is quite often underestimated with angiography. These thrombotic lesions are likely to increase the rate of intraprocedural complications including distal embolization, reocclusion after revascularization, and higher contrast use and radiation exposure. Treatment of these lesions is challenging and quite often requires the use of pharmaco-mechanical methods. Laser atherectomy with adjunctive balloon angioplasty is an effective technique in treating organized thrombotic lesions with high procedural success as a stand-alone therapy, or to facilitate wire crossing or as an adjunct to catheter directed lysis. Excimer laser leads to non-thermal ablation of the plaque and thrombus, suppresses platelet aggregation and enhances chemical lysis. Distal embolization remains a challenge in treating these thrombotic lesions but can be effectively prevented with the use of distal embolic filter protection in conjunction with laser therapy. It is speculated that thrombus ablation prior to a more definitive treatment of these subacute and thrombotic lesions will lead to a higher acute procedural success and improved long-term outcome, a hypothesis that needs to be tested in the future.