Percutaneous laser treatment of atherosclerosis: an overview of emerging techniques

In recent years, rapid progress in the application of lasers to the percutaneous treatment of atherosclerosis has been made. An overview of this progress is provided herein in terms of a description of promising laser approaches and problems to be solved. Direct vaporization of obstructing atheroma with fiberoptic delivery of laser energy has been associated with a high incidence of mural perforation, but each of a variety of techniques, including those for improved energy delivery, plaque recognition, alignment of the fiberoptic, and, perhaps, reduction of unnecessary thermal injury, has shown promise for reducing this complication. Nonablation applications of laser energy may also have a role in the treatment of atherosclerosis. During laser balloon angioplasty, the tissue coagulation effects of laser-thermal energy may be used during balloon inflation to eliminate arterial dissections and to reduce elastic recoil, thereby potentially eliminating abrupt reclosure and, perhaps, reducing the incidence of restenosis associated with conventional balloon angioplasty. Photochemical destruction of viable plaque tissue and vasa vasorum with porphyrins and intraarterial light represents a nonthermal, laser-based approach that could have a prophylactic role in slowing progression of diffuse atherosclerotic disease. The remarkable versatility of lasers is responsible for the multiplicity of approaches being investigated and for the current optimism that lasers will eventually play an important role in the percutaneous treatment of atherosclerosis.