A new model to study quantitative effects of laser angioplasty on human atherosclerotic plaque

A new model for analyzing the major effects of the use of any laser angioplasty system is described. Changes in any of the six major determinants of effect (energy, duration, wavelength, medium, absorption, geometry) can be evaluated. In this report a neodymium: yttrium aluminum garnet (Nd:YAG) laser was used to make 408 laser exposures in vitro on segments of human cadaveric atherosclerotic aorta. Energy, medium (air, human blood, perfluorochemical and saline), geometry and duration were varied. The depth and width of the resultant plaque craters were measured. A large amount of exposure to exposure variability was found in all groups of experiments, even when conditions were held as constant as possible in this rigidly controlled laboratory setting. This variability is attributable to differences in energy absorption by the plaque. Changes in media and fiber optic tip to plaque distance also markedly altered exposure outcome. For example, the average depth of the hole created by a 15 W, 2 second blast with the fiber tip adjacent to the plaque in blood was 1.7 +/- 0.1 mm (n = 27), but the range was between 0.5 and 2.7 mm. Under the same conditions, except with the fiber tip 1 mm away from the plaque, the average hole depth was 0.4 +/- 0.1 mm (n = 12) and the range was 0.0 to 1.7 mm. The use of this model to analyze the major determinants of lasing effects in different laser angioplasty systems should help to select the best conditions for lasing and allow assessment of the variability of outcome.