Laser balloon angioplasty. A new approach to abrupt coronary occlusion and chronic restenosis

Abrupt coronary occlusion and long-term restenosis continue to be the major problems associated with percutaneous transluminal coronary angioplasty (PTCA). Laser balloon angioplasty (LBA) is a technique designed to potentially alleviate these problems by sealing arterial dissections, smoothing the luminal surfaces, dehydrating thrombi, and reducing the elastic properties that tend to recoil the stretched artery to its original state. During LBA, laser energy is delivered circumferentially by a 100-microns optical fiber that terminates in a central diffusing tip within an angioplasty balloon. LBA is performed for 20 seconds during the final inflation of the angioplasty balloon. Achieved with decremental ramped laser dosimetry, Nd:YAG laser energy has been shown to be effective in welding experimental arterial dissections over a therapeutic temperature range of 95 degrees-120 degrees C. LBA treatment of rabbit iliac arteries has been superior to balloon angioplasty in inhibiting elastic recoil and causing acute and long-term luminal increment. LBA has also been effective for sealing acute dissections in atherosclerotic rabbit iliac arteries. Additionally, in a canine model, safety in the coronary circulation has been shown, that is, even at 1 month after LBA, angiography demonstrated a cast of the LBA balloon without luminal compromise. Since March 1988, more than 250 patients with symptomatic coronary artery disease have been treated with LBA with nearly uniform clinical success, including frequent reversal of abrupt closure. LBA seems to be a safe modality that may decrease the need for emergency operative procedures and late coronary revascularization after PTCA.