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Saline flush during excimer laser angioplasty: Short and long term effects in the rabbit femoral artery
Author(s) -
van Leeuwen Ton G.,
Velema E.,
Pasterkamp G.,
Post Mark J.,
Borst Cornelius
Publication year - 1998
Publication title -
lasers in surgery and medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.888
H-Index - 112
eISSN - 1096-9101
pISSN - 0196-8092
DOI - 10.1002/(sici)1096-9101(1998)23:3<128::aid-lsm2>3.0.co;2-r
Subject(s) - saline , medicine , excimer laser , excimer , lumen (anatomy) , femoral artery , intimal hyperplasia , angioplasty , necrosis , lesion , artery , surgery , pathology , laser , optics , physics , smooth muscle
Background and Objective: In this study, the effect of flushing saline on arterial wall damage (medial ruptures and necrosis), intimal hyperplasia, and arterial remodeling was determined. During excimer laser coronary angioplasty saline is flushed to reduce the size of explosive water vapor bubbles formed by intraluminal delivery of excimer laser pulses in blood. Methods In the femoral artery of the rabbit, 600 excimer laser pulses (308 nm, 50 mJ/mm 2 per pulse, 20 Hz) were delivered coaxially over a length of 20 mm in 10 bursts of 3 seconds each. In 24/48 procedures, saline was flushed (0.2 ml/s) via the guidewire channel. After 2 and 56 days, microscopic and angiographic results were compared. Results At 2 days, as compared to lasing in blood, saline flush had drastically reduced the incidence of dissections (2/12 vs. 11/12, P < 0.002), but had increased the extent of medial and adventitial necrosis. The latter is attributed to direct irradiation of the arterial wall. After 56 days, in the saline group, in the middle‐distal part of treated segments, medial necrosis without intimal hyperplasia was observed. However, at the edges of these lesions, intimal hyperplasia and arterial shrinkage reduced the lumen. Conclusion Flushing saline during coaxial excimer laser pulse delivery significantly reduced the incidence of vessel wall ruptures, and prevented intimal hyperplasia formation in part of the lesion. The histologic findings at 56 days are attributed to the optical window which the saline flush provides for direct ultraviolet light irradiation of the arterial wall. Lasers Surg. Med. 23:128–140, 1998. © 1998 Wiley‐Liss, Inc.