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Intravascular ultrasound guided Holmium:YAG laser recanalization of occluded arteries
Author(s) -
White Rodney A.,
Kopchok George E.,
Tabbara Marwan R.,
Cavaye Douglas M.,
Cormier Francois
Publication year - 1992
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.1900120302
Subject(s) - medicine , intravascular ultrasound , lumen (anatomy) , thrombus , radiology , perforation , debulking , stent , materials science , surgery , metallurgy , punching , ovarian cancer , cancer
Current angioplasty devices are limited by arterial wall dissection and perforation, and by early recurrence from inadequate debulking of lesions. This study evaluated intravascular ultrasound (IVUS) as guidance for concentric laser recanalization of arterial occlusions. Twelve, 2–4‐cm‐long canine iliac artery occlusions were treated at 2 weeks (organizing thrombus) to 12 weeks (firm fibrous lesions) using a Holmium:YAG laser (2,100 nm wavelength) in free running mode, FRM, (250 μsec pulse, 5 Hz), n = 9; and Q‐switched mode, QSM (200 ns pulse, 6 Hz), n = 3. A 200 μm (n = 2) or 600 μm (n=10) optic fiber was centered in the artery coaxial to a 5Fr rotating A scan IVUS probe. The fiber was positioned in the center of the artery distal to the lesion and slowly advanced through the obstruction. In 8 occlusions the same fiber was used as a guide wire for passage of either a 1.6‐mm‐(n=2) and/or 3.0‐mm (n=6) diameter multifiber catheter (19 × 100 and 19 × 200 μm fibers, respectively) using FRM energy to further debulk the lesion. In all cases, IVUS guidance enabled concentric initial recanalization of occlusions, although 3 vessel perforations resulted from fiber deviation off the center of the lumen at a distance of 2 to 4 cm from the IVUS imaging element. Both QSM and FRM modes ablated tissue, with FRM modes producing more tissue fragmentation and thermal effect. IVUS images accurately diagnosed the location of lesions compared to angioscopic views and pathologic analysis of the specimens. This study suggests that IVUS guided laser energy may enable initial concentric re‐canalization of arterial occlusions if adequate tissue removal can be accomplished to provide continuous IVUS imaging as the re‐canalization proceeds. © 1992 Wiley‐Liss, Inc.