The current status of laser angioplasty: coronary and peripheral results

It is pointed out that during the past decade considerable efforts have been devoted to the use of lasers coupled to fiber-optic catheter delivery systems to open atherosclerotic arterial narrowings in peripheral and coronary arteries. Continuous-wave lasers (argon and Nd:YAG) are able to create an opening, but because of thermal injury they have had a medically unacceptable high incidence of restenosis. Specially designed excimers and short pulsed near-IR systems have been shown to cause minimal thermal injury. In order to achieve a sufficiently large vessel lumen, however, a balloon dilatation (PTA/PTCA, or percutaneous transluminal peripheral and coronary angioplasty) is often done after the laser treatment, so that there is a double injury to the blood vessel wall, by the laser and by the balloon. Better understanding of the biology of the tissue reaction to injuries of various etiologies has led to the suspicion that shock wave injury has replaced the thermal injury with these new systems, since restenosis rates are still higher than for balloon dilatation alone. Some subsets of disease may have been detected recently for which the current laser systems offer some improvement in results compared to balloon dilatation. Many technical problems remain to be solved to achieve widespread benefit and use