Acute effects of argon laser on human atherosclerotic plaque

Although the laser has been demonstrated to vaporize coronary artery plaque, there is little information about its ability to resect or vaporize the range of plaques present in peripheral vessels. This study attempts to determine the ability of the argon laser to resect all grades of atherosclerotic plaque, the risk of perforation during plaque resection, the effects on surrounding arteries, and the effect of different transmission media (air, saline solution, and blood) on the delivery of laser energy to the vessel. Seventy-five adult human cadaveric aortic specimens with a range of atherosclerosis from grossly normal artery to extensive calcification with ulceration were exposed to variable energy densities (200 to greater than 20,000 J/cm2) within 48 hours of harvesting. Specimens were examined grossly for the visual effects of laser and microscopically after preparation with hematoxylin-eosin, trichrome, and/or Verhoeff's elastin stains. Our results indicate that normal arteries and noncalcified plaques absorb laser energy and are vaporized. As the atherosclerosis becomes more complex with calcification, calcified regions are not vaporized and cannot be resected. In normal arteries and noncalcified plaque, perforation times were less than 5 seconds. Where palpable calcification was present in atherosclerotic lesions, average perforation time was doubled. In some vessels areas of calcification prevented wall perforation, but areas of subintimal hemorrhage perforated rapidly because of the selective absorption of laser energy by the red color of hemorrhagic tissue. These results remain the same when saline solution is used as a transmission media, although the amount of energy required to achieve the effects is increased.(ABSTRACT TRUNCATED AT 250 WORDS)