Laser Angioplasty

Since the development of the first laser generator by Maiman in 1960, laser energy has gained increased interest and has subsequently been used in various fields of applica tion. Due to its high energy density, combined with a sharply defined irradiation field, laser has aroused great expectations, especially since laser beams have been used very successfully in various fields especially technology and medicine. Medical and surgical applications of the laser were among the first and have been of undisputed benefit in, for example, ophthalmologic interventions such as coagulation of the retina, or for endoscopic tumorectomy in the bronchial, gastrointestinal and urogenital tracts. Consequently, considerable research effort was made to also apply laser techniques in interventional cardiology for the treatment of atherosclerosis, aimed at removing plaque material from stenosed tissue or occluded ateries and recanalizing tough and calcified segments unsuitable for the well-extablished technique of balloon dilatation. Ablating atheroma rather than pushing it aside was thought to achieve better results. However, it was found that the laser may create rough-edged cuts partly with substantial thermal or mechanical damage to the surrounding tissue, consequently provoking preconditions for unwanted restenosis. Different types of laser generators and probes have therefore been investigated in arterial vessels, mostly focusing on indirect laser effects. Intravasal probes with laser heated metal tips were used, as well as balloon catheters with an incorporated laser fiber designed to heat the surrounding tissue outside the balloon and to, ineffect, "iron out the plaque".

A comprehensive guide to the clinical use of lasers in cardiovascular disease. Describes techniques of laser angioplasty, covering topics that range from early results using bare fiber optics to percutaneous coronary laser thermal angioplasty. Extensively illustrated with photographs, x-rays, angiograms, drawings and diagrams.

Since the development of the first laser generator by Maiman in 1960, laser energy has gained increased interest and has subsequently been used in various fields of applica tion. Due to its high energy density, combined with a sharply defined irradiation field, laser has aroused great expectations, especially since laser beams have been used very successfully in various fields especially technology and medicine. Medical and surgical applications of the laser were among the first and have been of undisputed benefit in, for example, ophthalmologic interventions such as coagulation of the retina, or for endoscopic tumorectomy in the bronchial, gastrointestinal and urogenital tracts. Consequently, considerable research effort was made to also apply laser techniques in interventional cardiology for the treatment of atherosclerosis, aimed at removing plaque material from stenosed tissue or occluded ateries and recanalizing tough and calcified segments unsuitable for the well-extablished technique of balloon dilatation. Ablating atheroma rather than pushing it aside was thought to achieve better results. However, it was found that the laser may create rough-edged cuts partly with substantial thermal or mechanical damage to the surrounding tissue, consequently provoking preconditions for unwanted restenosis. Different types of laser generators and probes have therefore been investigated in arterial vessels, mostly focusing on indirect laser effects. Intravasal probes with laser heated metal tips were used, as well as balloon catheters with an incorporated laser fiber designed to heat the surrounding tissue outside the balloon and to, ineffect, "iron out the plaque".

Following the advent of percutaneous balloon vel oped and are available for clinical use, as well angioplasty, interventional cardiovascular pro as those that are still in investigational phases. cedures have become of great interest to the Clinical case reports are presented by expert in cardiologist, radiologist, and cardiovascular vestigators on the use of various catheter systems surgeon. One of the most extensively explored in the coronary and peripheral circulation. alternatives to bypass surgery is laser-mediated Part V (Chapters 17-23) is the most up-to angioplasty. The fascination with laser radia date review of the clinical experience with vari tion has greatly contributed to its popularity, ous laser delivery systems. There is an emphasis but has also burdened it with unrealistic ex on patient selection, criteria for lesion choice, pectations. Many commercial laser systems are and follow-up data. A detailed description of available to the clinician and the researcher, laser recanalization techniques is presented for which often makes the choice of a laser system the various systems in the clinical setting.

​​Since the introduction of laser devices to the medical sciences this technology has created great interest. Specifically, the laser’s unique physical properties and precise bio-tissue interactions render this versatile source of biologic energy an attractive tool for multiple therapeutic purposes in cardiovascular medicine. Over the course of the last 2 decades the utilization of laser technology has become an important component for the management of patients with complex cardiovascular diseases. During this time period, cutting edge laser technology including a variety of wave length generators, newly designed catheters, and a selection of advanced optic fibers have been introduced and applied in the cardiovascular circulation. Improved lasing techniques in the cardiac catheterization suites and operation rooms have been implemented for treatment of ischemic coronary syndromes, peripheral arterial occlusive disease and other atherosclerotic thrombotic conditions. Moreover, during this 20 year time frame, several multicenter and single center clinical studies have been published focusing on the role and utilization of lasers in coronary and peripheral revascularization. And within the rapidly expanding field of interventional cardiac electrophysiology, laser technology has recently revolutionized the management of fractured, abandoned and malfunctioning leads of cardiac pacemakers and automatic defibrillators. Consequently, replacing a notoriously cumbersome and high risk open heart surgery with safe and markedly efficient percutaneous laser based extraction. This textbook will provide the most authoritative, comprehensive and contemporary information covering technological progress, clinical experience and pertinent aspects of laser applications in cardiovascular medicine. It will be of interest to cardiologists, vascular surgeons and interventional radiologist as well as medical students, scientists, biomedical engineering students and graduates.​