Rosenthal E, Montarello J K, Palmer T, Curry P V
Department of Cardiology, Guy's Hospital, London.
Lasers Surg Med. 1989;9(3):229-36. doi: 10.1002/lsm.1900090305.
Percutaneous laser thermal probe angioplasty requires sufficient laser probe flexibility to access the coronary tree. This may entail a loss of axial strength and the resultant slow advancement may lead to unwanted heating of the normal coronary artery proximal to the lesion. To assess the lateral thermal effects of stationary coronary laser probes, laser thermal energy (50-150 J) was delivered to 25 coronary artery segments (diameter 1.9-4.0 mm) in a perfused cadaver heart preparation using a 1.7 mm tip probe. Adherence to the vessel wall occurred in 19 segments, endothelial charring in 8 segments, and perforation in 3 segments. Endothelial charring was seen in 8 of 13 nonperfused segments but in 0 of 12 segments perfused at 60 ml/minute (P less than 0.01). In all three perforations the vessel to probe diameter ratio was less than 1.6:1, perfusion was absent, and traction to dislodge the adherent probe was necessary. Lateral wall damage is a complication of stationary laser probes: smaller-tipped probes which are advanced rapidly at the time of energy delivery may enhance the safety margins of coronary laser thermal probe angioplasty.
经皮激光热探头血管成形术需要激光探头具备足够的柔韧性以进入冠状动脉树。这可能会导致轴向强度的损失，而由此产生的推进缓慢可能会使病变近端的正常冠状动脉出现不必要的发热。为了评估固定冠状动脉激光探头的侧向热效应，使用1.7毫米尖端探头，将激光热能（50 - 150焦耳）输送到灌注尸心标本中的25个冠状动脉节段（直径1.9 - 4.0毫米）。19个节段出现血管壁粘连，8个节段出现内皮炭化，3个节段出现穿孔。在13个未灌注节段中有8个出现内皮炭化，但在以60毫升/分钟灌注的12个节段中未出现（P小于0.01）。在所有3例穿孔中，血管与探头直径比均小于1.6:1，无灌注，且需要牵引以移除粘连的探头。侧壁损伤是固定激光探头的一种并发症：在能量输送时快速推进的较小尖端探头可能会提高冠状动脉激光热探头血管成形术的安全范围。
