Geschwind H J, Aptecar E, Boussignac G, Dubois-Randé J L, Zelinsky R, Poirot G, Tomaru T
Cardiac Catheterization Laboratory, University Hospital Henri Mondor, Créteil, France.
Circulation. 1991 Mar;83(3):787-96. doi: 10.1161/01.cir.83.3.787.
Few data are available on the long-term outcome of patients who undergo laser-assisted balloon angioplasty for recanalization of occluded peripheral arteries. Because the cost of laser angioplasty is high, the value of the method should be carefully analyzed before it can be considered a routine method for recanalization. The purpose of this study was to evaluate the early and late results of laser-assisted balloon angioplasty in patients who could not be recanalized by conventional techniques.
Laser angioplasty was performed in 66 patients with total occlusion of the iliofemoral artery in whom mechanical techniques failed to recanalize the obstructed vessel. The system consisted of a pulsed dye laser operated at 480 nm, 2 microseconds/pulse, 5 Hz, 50 mJ/pulse coupled into a 0.021-in. laser catheter. The treatment laser was connected with a diagnostic laser to induce tissue fluorescence for spectroscopic analysis via the same fiber. The treatment laser was emitted only when atheromatous tissue was recognized. After a pilot hole was created by laser emission, dilatation was performed to enlarge the channel. The mean length of occlusion was 8.8 +/- 6.1 cm. The primary success rate was 82%. It did not depend on the length of occlusion but was greater in non-calcified than in calcified lesions (88% versus 71%, p less than 0.03). Complications included seven early reocclusions that could be recanalized and eight perforations without clinical sequelae. At a mean 18-month follow-up, 64% of the laser-treated arteries remained patent. The rate of patency was related neither to the length of the occlusion nor to calcifications but was lower in patients who had early reocclusion (p less than 0.02).
Pulsed dye laser-assisted balloon angioplasty is effective for recanalization of totally occluded arteries that cannot be treated by conventional means. The efficacy is limited by calcifications. The long-term patency rate is acceptable given the severity of the lesions.
关于接受激光辅助球囊血管成形术以再通闭塞性外周动脉的患者的长期预后，可用数据很少。由于激光血管成形术成本高昂，在其被视为再通的常规方法之前，应仔细分析该方法的价值。本研究的目的是评估激光辅助球囊血管成形术在无法通过传统技术再通的患者中的早期和晚期结果。
对66例股浅动脉完全闭塞且机械技术无法再通阻塞血管的患者进行了激光血管成形术。该系统由一台脉冲染料激光组成，其工作波长为480nm，脉冲宽度为2微秒，频率为5Hz，脉冲能量为50mJ，耦合到一根0.021英寸的激光导管中。治疗激光与诊断激光相连，通过同一根光纤诱导组织荧光进行光谱分析。仅在识别出粥样硬化组织时才发射治疗激光。通过激光发射形成先导孔后，进行扩张以扩大通道。平均闭塞长度为8.8±6.1cm。主要成功率为82%。它不取决于闭塞长度，但在非钙化病变中高于钙化病变（88%对71%，p<0.03）。并发症包括7例可再通的早期再闭塞和8例无临床后遗症的穿孔。平均随访18个月时，64%接受激光治疗的动脉仍保持通畅。通畅率既与闭塞长度无关，也与钙化无关，但在早期再闭塞的患者中较低（p<0.02）。
脉冲染料激光辅助球囊血管成形术对于无法通过传统方法治疗的完全闭塞动脉的再通是有效的。疗效受钙化限制。鉴于病变的严重程度，长期通畅率是可以接受的。
