Laser angioplasty. Why use a laser and what type to use

Percutaneous transluminal coronary angioplasty (PTCA) is the primary method of less invasive coronary disease therapy, offering an alternative to bypass surgery yearly for over 200,000 patients in the United States. It has, in fact, revolutionized the treatment of coronary artery disease since the late 1970s, but since lasers appeared on the scene, the medical community is asking questions. Will the laser replace PTCA? Is laser angioplasty going to be the new preferred method of non-invasive treatment? For that matter, are all lasers alike for treatment of coronary artery disease? Whatever the advantages of laser angioplasty, we must dissociate ourselves from the glamour of the high technology of laser angioplasty and observe the current and future advantages of removing atherosclerotic plaque using photoablation compared to the less expensive low technology solution of PTCA or atherectomy. An analysis of the differences in assorted choice of laser sources for laser angioplasty for tissue ablation and the delivery of this energy percutaneously through flexible fiber optic based catheters are discussed. All lasers do not remove tissue by the same physical mechanism and, therefore, should not be lumped together generically as laser angioplasty. In most cases, different lasers do not offer similar advantages for treatment of coronary disease. A discussion of the differentiation between various laser options, the current niche use oflaser angioplasty as an adjunctive therapy to PTCA and the future potential for laser angioplasty are presented