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Fluorescence spectroscopy guidance of laser ablation of atherosclerotic plaque
Author(s) -
Deckelbaum Lawrence I.,
Stetz Mark L.,
O'Brien Ken M.,
Cutruzzola Francis W.,
Gmitro Arthur F.,
Laifer Lawrence I.,
Gindi Gene R.
Publication year - 1989
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/lsm.1900090303
Subject(s) - ablation , laser ablation , laser , materials science , laser induced fluorescence , fluorescence spectroscopy , angioplasty , spectroscopy , biomedical engineering , medicine , fluorescence , optics , radiology , physics , quantum mechanics
Laser‐induced fluorescence (LIF) spectroscopy can only be used for laser angioplasty guidance if high‐power laser ablation does not significantly alter the pattern of tissue fluorescence. Although the spectra of normal and atherosclerotic arteries differ, the change in fluorescence spectra following laser angioplasty has not been well studied. Therefore, the purpose of this study was to assess whether laser‐induced fluorescence spectroscopy could guide selective laser ablation of atherosclerotic plaque and, if so, to develop a quantitative LIF score that could be used to control a “smart” laser angioplasty system. Baseline LIF spectroscopy of 50 normal and 50 atherosclerotic human aortic specimens was performed using an optical fiber coupled to a He‐Cd laser and optical multichannel analyzer. LIF was then serially recorded during erbium:YAG laser ablation of 27 atherosclerotic specimens. Laser ablation was terminated when the arterial LIF spectrum visually appeared normal. Histologic analysis revealed a mean initial plaque thickness of 1,228 ± 54 μm and mean residual plaque thickness of 198 ± 27 μm. Ablation of the media occurred in only three specimens. A discriminant function was derived to discriminate atherosclerotic from normal tissue for computer guidance of laser angioplasty. The LIF score, derived from stepwise multivariate linear regression analysis of the LIF spectra, correctly classified 93% of aortic specimens. The spectra obtained from the atherosclerotic specimens subjected to fluorescence‐guided laser revealed a change in score from “atherosclerotic” to “normal” following plaque ablation. Seven atherosclerotic specimens were subjected to laser angioplasty with on‐line computer control using the LIF score. Mean initial plaque thickness was 1,014 ± 86 μm, and mean residual plaque thickness was 78 ± 29 μm. There was no evidence of ablation of the media. Therefore, LIF guidance of laser ablation resulted in minimal residual plaque without arterial perforation. These findings support the feasibility of an LIF‐guided laser angioplasty system for selective atherosclerotic plaque ablation.