Tomaru T, Geschwind H J, Boussignac G, Lange F, Tahk S J
Explorations Fonctionnelles, Henri Mondor Hospital, University of Paris XII, Créteil, France.
Am Heart J. 1992 Apr;123(4 Pt 1):886-95. doi: 10.1016/0002-8703(92)90692-o.
Ablation efficacy of pulsed lasers on human arterial tissue and associated shock waves have been investigated by means of excimer laser at 308 nm, pulsed-dye laser at 480 nm, and holmium-YAG laser at 2.1 microns. A multifiber catheter was used for lasing at 420 mjoules/pulse with holmium-YAG, 18.9 mjoules/pulse with excimer, and 100 mjoules/pulse with pulsed-dye laser. Ablation efficiency (ablated volume/energy) was greatest with pulsed-dye laser in blood and excimer laser in saline solution. There was selectivity for atheroma with pulsed-dye laser (ablation efficiency in atheroma versus normal tissue, 58 versus 27 x 10(-2) mm3/joule in blood; p less than 0.005) and holmium-YAG laser (12.6 versus 5.6 x 10(-2) mm3/joule in blood; p less than 0.001). Ablation efficiency of pulsed-dye laser was enhanced by blood (0.58 in blood versus 0.17 mm3/joules in saline for atheroma; p less than 0.005). Shock waves were correlated with ablation efficiency (r = 0.63 and 0.74 for pulsed-dye laser and holmium-YAG laser, respectively). There was neither selectivity for atheroma nor influence of blood medium with excimer laser. Only holmium-YAG laser could ablate tissue at a distance from the target in the blood medium. Histologic findings showed that all lasers could create smooth-edged craters with minimal coagulation necrosis. In conclusion, laser irradiation with holmium-YAG and pulsed-dye lasers could selectively ablate atheromatous tissue with minimal thermal injury, whereas excimer laser could not. Ablation efficiency was correlated with shock waves. Efficiency of pulsed-dye laser was enhanced by blood.
通过308纳米的准分子激光、480纳米的脉冲染料激光和2.1微米的钬钇铝石榴石激光，研究了脉冲激光对人体动脉组织的消融效果及相关冲击波。使用多光纤导管，钬钇铝石榴石激光以420毫焦/脉冲、准分子激光以18.9毫焦/脉冲、脉冲染料激光以100毫焦/脉冲进行激光照射。在血液中，脉冲染料激光的消融效率（消融体积/能量）最高；在盐溶液中，准分子激光的消融效率最高。脉冲染料激光对动脉粥样硬化斑块有选择性（在血液中，动脉粥样硬化斑块与正常组织的消融效率分别为58对27×10⁻²立方毫米/焦耳；p＜0.005），钬钇铝石榴石激光也有选择性（在血液中为12.6对5.6×10⁻²立方毫米/焦耳；p＜0.001）。血液可提高脉冲染料激光的消融效率（动脉粥样硬化斑块在血液中的消融效率为0.58，在盐溶液中为0.17立方毫米/焦耳；p＜0.005）。冲击波与消融效率相关（脉冲染料激光和钬钇铝石榴石激光的r分别为0.63和0.74）。准分子激光对动脉粥样硬化斑块既无选择性，血液介质对其也无影响。只有钬钇铝石榴石激光能在血液介质中距靶点一定距离处消融组织。组织学检查结果显示，所有激光均可形成边缘光滑的弹坑，且凝固性坏死最小。总之，钬钇铝石榴石激光和脉冲染料激光照射可选择性消融动脉粥样硬化组织，热损伤最小，而准分子激光则不能。消融效率与冲击波相关。血液可提高脉冲染料激光的效率。
