Laser-assisted percutaneous angioplasty: initial clinical experience in peripheral arteries

Experimental and animal studies have shown that laser energy can vaporize intra-vascular thrombus and atheroma, suggesting that it may have a role in percutaneous angioplasty. Argon laser energy transmitted via a flexible fibre introduced through a percutaneous catheter was used in 15 patients undergoing balloon angioplasty of femoral or popliteal arteries. Of four stenoses, laser alone produced improvement of the lumen in two. Of 11 occlusions some degree of clearance of the lumen was achieved by laser in eight prior to balloon dilatation. Extravasation of contrast medium indicating wall perforation occurred in two patients, without clinical sequelae. No other complications, such as embolism, arterial spasm or toxic effects were observed. There was one acute re-occlusion, almost certainly not related to the use of laser. There have been no late complications. The ability of laser to influence favourably vascular occlusion is confirmed, but technical advances are necessary to avoid vessel wall perforation consistently and to improve the production of an adequate lumen before its potential can be fully realized.