Biamino Giancarlo
Clinical and Interventional Angiology, Heart Center Leipzig, Germany.
J Endovasc Ther. 2004 Dec;11 Suppl 2:II207-22. doi: 10.1177/15266028040110S615.
Nearly 20 years ago, in vitro experiments left no doubt about the fact that laser light can ablate atherosclerotic plaque. The initial enthusiastic results with the technology, particularly in coronary arteries, were followed by reports showing unacceptably high restenosis and complication rates. These poor results were due to the premature application of an underdeveloped technology, a lack of understanding of laser/tissue interaction, and the use of incorrect lasing techniques. Consequently, and without discrimination, all lasers were banned from the catheterization laboratories for nearly a decade. Technological enhancements of the excimer laser, combined with refined catheter lasing techniques, resulted in greater debulking of atherosclerotic material in long superficial femoral artery occlusions. These results triggered the application of the excimer laser technique as an atherectomy tool in more complex lesions below the knee. The multicenter Laser Atherectomy for Critical Ischemia study clearly demonstrated that the excimer laser technology resulted in limb salvage rates >90% in patients with critical limb ischemia (CLI). Furthermore, new clinical results indicate that the excimer laser is very effective in dissolving thrombotic obstructions, redirecting this technology to the coronary field. The results of the excimer laser in CLI validate the role of the cool laser in treating complex peripheral vascular disease. The results suggest a larger indication for this technology and support a more aggressive use of these interventional techniques in the treatment of this large patient cohort. However, all lasers are not equally effective in debulking atherosclerotic material. Only the athermic process associated with the excimer laser produces a safe and effective endovascular ablation of obstructive atherosclerotic and/or thrombotic material. The appropriate and safe utilization of the equipment and lasing techniques, combined with correct indications and patient selection, will contribute to the successful application of laser-assisted atherectomy in complex peripheral and coronary artery obstructive disease. Unfortunately, little consistent scientific data has been generated to convince the interventional community of the usefulness of excimer laser ablation.
近20年前，体外实验确凿无疑地证明激光能够消融动脉粥样硬化斑块。该技术最初取得了令人振奋的成果，尤其是在冠状动脉方面，但随后有报告显示再狭窄率和并发症发生率高得令人难以接受。这些糟糕的结果是由于过早应用了一项尚不成熟的技术、对激光与组织相互作用缺乏了解以及使用了错误的激光技术。因此，毫无差别地，所有激光在近十年内都被禁止用于导管室。准分子激光的技术改进，结合精细的导管激光技术，在长段股浅动脉闭塞病变中能更有效地去除动脉粥样硬化物质。这些结果促使准分子激光技术被应用于膝以下更复杂的病变作为斑块旋切工具。多中心严重肢体缺血激光斑块旋切研究清楚地表明，准分子激光技术使严重肢体缺血（CLI）患者的肢体挽救率超过90%。此外，新的临床结果表明准分子激光在溶解血栓性阻塞方面非常有效，从而将该技术重新引入冠状动脉领域。准分子激光在CLI中的结果证实了冷激光在治疗复杂外周血管疾病中的作用。这些结果表明该技术有更广泛的适应证，并支持在治疗这一庞大患者群体时更积极地使用这些介入技术。然而，并非所有激光在去除动脉粥样硬化物质方面都同样有效。只有与准分子激光相关的无热过程才能对阻塞性动脉粥样硬化和/或血栓性物质进行安全有效的血管内消融。设备和激光技术的恰当、安全使用，结合正确的适应证和患者选择，将有助于激光辅助斑块旋切术在复杂外周和冠状动脉阻塞性疾病中的成功应用。不幸的是，几乎没有一致的科学数据能让介入医学界相信准分子激光消融的有效性。
