Lasers in cardiovascular medicine

The role of lasers in cardiovascular medicine and surgery is a rapidly evolving and uncertain field. Many alternative percutaneous techniques and technologies for removal of atherosclerotic plaque are under development. However, according to many clinicians, atherectomy devices that bore through occlusions with high speed burrs, shave them away with miniature knives, or micropulverize them with ultrasonic waves will be complements not substitutes to both lasers and balloons. Thus, it is unlikely that a cost-effective substitute for the laser is likely to come from developments in mechanical ablation systems. It is important to keep in mind that peripheral laser angioplasty is still considered of benefit to a small percentage of all candidates for peripheral percutaneous transluminal angioplasty, and that coronary laser angioplasty is strictly investigational. Although more devices may be approved in the next year, only two are available on the open market at publication, and both are approved only for peripheral angioplasty. With the rapid growth in the number of laser manufacturers entering the market, there are ample opportunities for large hospitals with active cardiology and cardiovascular surgery programs to become trial sites. However, the smaller hospital set on entering the market may want to consider only well-established, FDA approved technologies that are reasonably priced.