UV Photoablation of Atherosclerotic Lesions. Application in Cardiology

S Avrillier,I Gandjbakhch,E Delettre,E Tinet,J L Bussieref,J P Ollivier

doi:10.1155/1990/91308

Abstract

Various methods for the ablation of the atherosclerotic material that fills the coronary arteries are under investigation. Among them laser coronary angioplasty is one of the most promising. In this paper we show that the XeCl excimer laser (308 nm) offers many advantages which make it appear as a rather good tool. In vitro studies demonstrate the ability of precise control of the UV photoablation process, there is no thermal damage and the risk of perforation is reduced. A suitable laser‐fiber optic delivery system has been developed and the results of the first in vivo procedures are very encouraging.

Highlights

Cardiovascular diseases are the foremost cause of death in France
Human coronary atherosclerosis is generally a diffuse disease, it lends itself to surgical by-pass procedures because the major site of plaque formation is usually distributed near the aorta
The selection of the appropriate laser for coronary angioplasty is based on the following criteria" the quality of the cuts related to the structural integrity of the adjacent tissues and their short term or long term response, the ability of precise control of the ablation process to ayoid perforation or dissection, the suitability of the fiber optic delivery system with respect to the fluences required for the arterial plaque ablation, the laser size, reliability and serviceability for current use in hospitals

Summary

INTRODUCTION

Cardiovascular diseases are the foremost cause of death in France. Narrowing of coronary arteries by atherosclerotic plaque, composed of complex lipid, fibrous and calcified materials, reduces the myocardial vascularization and is often associated with acute infarction. In the last decade, percutaneous balloon angioplasty has been a major advance in interventional therapy of coronary obstructions. This technique is less traumatic and less expensive than bypass surgery. The long-term and mid-term results of myocardial revascularization by direct surgical coronary by-pass or percutaneous balloon angioplasty are often compromised by progressive restenosis. As many as 20% of coronary arteries are inoperable because of diffuse and/or calcified disease This problem calls for the development of other techniques: it seems more logical to try to remove the atherosclerotic material that fills the vascular lumen rather than to by-pass it or to flatten it. The selection of the appropriate laser for coronary angioplasty is based on the following criteria" the quality of the cuts related to the structural integrity of the adjacent tissues and their short term or long term response, the ability of precise control of the ablation process to ayoid perforation or dissection, the suitability of the fiber optic delivery system with respect to the fluences required for the arterial plaque ablation, the laser size, reliability and serviceability for current use in hospitals

UV PHOTOABLATION PROCESS

LASER DELIVERY SYSTEM AND FIRST IN VIVO PROCEDURES

FUTURE DEVELOPMENTS OF THE TECHNIQUE

Central Lumen

Findings

CONCLUSION