Karsch K R, Haase K K, Mauser M, Ickrath O, Voelker W, Duda S, Seipel L
Medical Clinic, Department of Cardiology, Eberhard-Karls-University, Tübingen, Federal Republic of Germany.
Lancet. 1989 Sep 16;2(8664):647-50. doi: 10.1016/s0140-6736(89)90895-7.
A novel 1.3 mm diameter laser catheter, consisting of 20 concentric 100 microns quartz fibres around a central lumen for a 0.35 mm flexible guide wire, was used to ablate atherosclerotic tissue in thirty patients with coronary artery disease. The laser catheter was coupled to an excimer laser delivering energy at a wavelength of 308 nm and a pulsewidth of 60 ns. The primary success rate was 90% (27 of 30 lesions). The mean (SD) percentage stenosis fell from 85 (15)% to 41 (19)% after laser ablation. In ten patients the lumen diameter after laser angioplasty was considered sufficient, but subsequent balloon angioplasty was carried out for the other twenty patients. Failure to pass the lesion was caused by vessel kinking in two patients and a total occlusion in one patient. No complications directly attributable to laser ablation, such as vessel wall perforation, occurred; one dissection occurred but had no clinical sequelae. There was one early reocclusion and death in a patient with triple vessel disease and unstable angina, probably as a result of plaque rupture after balloon angioplasty. These results are encouraging and justify further clinical investigations.
一种新型的直径为1.3毫米的激光导管，由围绕着用于0.35毫米柔性导丝的中心腔的20根同心的100微米石英纤维组成，被用于对30例冠心病患者的动脉粥样硬化组织进行消融。该激光导管与一台准分子激光相连，该激光以308纳米的波长和60纳秒的脉冲宽度输送能量。主要成功率为90%（30处病变中的27处）。激光消融后，平均（标准差）狭窄百分比从85（15）%降至41（19）%。10例患者激光血管成形术后的管腔直径被认为足够，但另外20例患者随后进行了球囊血管成形术。2例患者因血管扭结、1例患者因完全闭塞导致未能通过病变部位。未发生直接归因于激光消融的并发症，如血管壁穿孔；发生了1例夹层，但无临床后遗症。1例三支血管病变和不稳定型心绞痛患者出现早期再闭塞并死亡，可能是球囊血管成形术后斑块破裂所致。这些结果令人鼓舞，值得进一步进行临床研究。
