Mechanisms of microvascular response to laser pulses

"Selective photothermolysis" is widely used for treating vascular lesions. In order to understand mechanisms of response, we investigated fast events during pulsed laser treatment of microvessels. A high-speed (2000 fps) CCD camera and microscope were used to image hamster cheek pouch microvessels during and after 532 nm and 1064 nm laser pulse exposures. Pulse duration and fluence were varied systematically (1-50 ms, 0-600 J per cm2). Threshold fluences for fast events were determined. On a millisecond time-scale, a specific series of fast events occur, which are wavelength, fluence, irradiance, and pulse duration dependent. In order of increasing fluence we observed: blood coagulation, vasoconstriction, thread-like appearance of the treated vascular segment, vessel disappearance, intravascular cavitation, bubble formation, vessel wall rupture and hemorrhage, and shrinkage of perivascular tissue. With increasing pulse duration, the threshold fluences for coagulation, vessel disappearance, and cavitation increase, and cavitation becomes less violent, conforming to the vessel lumen. Intravascular cavitation did not always rupture the vessel wall, and is not the mechanism for immediate vessel disappearance, a desired endpoint for treating vascular lesions. The apparent mechanism for immediate vessel disappearance is contraction of intravascular blood and perivascular collagen after thermal denaturation. This study suggests that detecting fast events in humans, in real time, may provide useful feedback signals for "smarter" laser devices.