Initial experience with the "Smart" laser in the treatment of atherosclerotic occlusions.

A dual laser system capable of distinguishing atherosclerotic plaque from components of normal arterial wall was used to deliver laser energy to cut a channel through occluded vessels. This system was used to facilitate balloon angioplasty of short (3-17 cm) total occlusions of the superficial femoral or popliteal arteries in 17 patients. In 10 patients the occluding lesion was traversed by the laser wire and patency was effectively restored by balloon angioplasty. Satisfactory luminal patency has persisted for 2 to 12 months (mean 6 months) in 9 cases; the lesion in the tenth patient restenosed at 3 months. The laser procedure was unsuccessful in all 3 cases with occlusions over 10 cm and in 4 others. There were no clinically important complications. This experience suggests that most patients who presently require interventional treatment can be managed by standard angioplasty methods and/or require a bypass operation. The "Smart" laser is safe and effective short-term in facilitating angioplasty in some patients in whom standard angioplasty techniques are not feasible. The implications of these findings are discussed.