Buchwald A, Werner G S, Unterberg C, Voth E, Figulla H R, Wiegand V
Abteilung für Kardiologie und Pulmonologie, Georg-August-Universität Göttingen.
Z Kardiol. 1989 Nov;78(11):714-8.
Excimer-laser-angioplasty offers the advantage of minimal thermal injury to adjacent tissue compared to other laser ablation techniques. Highly flexible glass-fiber-catheter systems are now available, and are capable of transmitting sufficient energy densities to ablate even calcified atherosclerotic coronary plaques. We report initial results of excimer-laser-ablation of severe coronary stenoses and occlusions in 17 patients. An excimer-laser (308 nm) with a pulse duration of 50 ns and a repetition rate of 10 to 40 Hz served as laser source. Eight patients had a chronic total occlusion (RCA, n = 4, RCx, n = 3, LAD, n = 1), nine patients had 90% to 95% stenoses (LAD, n = 7, RCA, n = 2). In all cases a laser-catheter consisting of 17 circumferentially orientated 100 microns glass-fibers and a central 15/1000-inch lumen could be advanced to the stenoses/occlusion over a guidewire that had been passed across the stenoses/occlusion. Stenoses diameter could be reduced by 41.5 +/- 10.1% in all patients and vessel lumen was further increased by subsequent balloon dilatation in 10 cases. After 24 h, 16 vessels were patent and showed no restenoses; one recanalized RCA was found reoccluded. We observed no complications, such as perforation, spasm, or thrombi.
与其他激光消融技术相比，准分子激光血管成形术具有对相邻组织热损伤最小的优点。现在已有高度灵活的玻璃纤维导管系统，其能够传输足够的能量密度以消融甚至钙化的动脉粥样硬化冠状动脉斑块。我们报告了17例患者严重冠状动脉狭窄和闭塞的准分子激光消融的初步结果。脉冲持续时间为50纳秒、重复频率为10至40赫兹的准分子激光（308纳米）用作激光源。8例患者存在慢性完全闭塞（右冠状动脉，4例；左回旋支，3例；左前降支，1例），9例患者存在90%至95%的狭窄（左前降支，7例；右冠状动脉，2例）。在所有病例中，由17根周向排列的100微米玻璃纤维和一个15/1000英寸的中央管腔组成的激光导管能够通过已穿过狭窄/闭塞部位的导丝推进至狭窄/闭塞部位。所有患者的狭窄直径可减小41.5±10.1%，10例患者随后通过球囊扩张使血管腔进一步增大。24小时后，16条血管通畅且无再狭窄；发现1例再通的右冠状动脉再次闭塞。我们未观察到诸如穿孔、痉挛或血栓形成等并发症。
