Geschwind H, Fabre M, Chaitman B R, Lefebvre-Villardebo M, Ladouch A, Boussignac G, Blair J D, Kennedy H L
J Am Coll Cardiol. 1986 Nov;8(5):1089-95. doi: 10.1016/s0735-1097(86)80386-2.
Laser recanalization of occluded femoral or popliteal arteries was performed in 12 patients using a continuous wave neodymium yttrium aluminum garnet (Nd-YAG) laser. The histologic findings of the laser-irradiated arterial segments in two of these patients are reported. The specimens were obtained 2 and 4 weeks after the laser procedure. The laser-irradiated vessel in Patient 1 had been partially recanalized with reduction of the atherosclerotic occlusion from 3 to 1 cm. The lased arterial lumen manifested thermal injury to the inner quarter of the arterial wall with vacuolization and a rim of carbonization occupying 10% of the width of the arterial wall, but without thrombus formation. Histologic examination in Patient 2 revealed no fibrin deposits, atherosclerotic debris or thrombi at the intimal arterial edge. At the crater site, thermal injury was apparent with vacuolization of the intimal fibrous tissue. The histologic sections obtained 4 weeks after the procedure revealed new fibrous intimal tissue without endothelialization in some of the heavily calcified tissue sections. Where the plaques were noncalcified, reendothelialization was noted with only minimal damage to the surrounding tissue. No medial or elastic fiber disruption was seen, and no aneurysmal dilation had occurred. Intimal splitting with a cleft between the tunica media and the intima was noted at the site of previous balloon angioplasty. In conclusion, the follow-up histologic findings 2 and 4 weeks after laser angioplasty in two patients using a specially designed catheter delivery system and cooling blood perfusate revealed thermal injury to the inner quarter of the arterial vessel wall and no evidence of thrombus formation.
使用连续波钕钇铝石榴石（Nd-YAG）激光对12例患者闭塞的股动脉或腘动脉进行了激光再通术。报告了其中2例患者激光照射动脉段的组织学结果。标本在激光手术后2周和4周获取。患者1的激光照射血管已部分再通，动脉粥样硬化闭塞从3厘米减少到1厘米。激光照射后的动脉腔显示动脉壁内四分之一有热损伤，出现空泡化，碳化边缘占动脉壁宽度的10%，但无血栓形成。患者2的组织学检查显示动脉内膜边缘无纤维蛋白沉积、动脉粥样硬化碎片或血栓。在弹坑部位，内膜纤维组织空泡化，热损伤明显。手术后4周获得的组织学切片显示，在一些重度钙化的组织切片中，有新的纤维内膜组织但无内皮化。在斑块未钙化的部位，可见内皮再形成，对周围组织的损伤最小。未见中膜或弹性纤维破坏，也未发生动脉瘤样扩张。在先前球囊血管成形术的部位，可见中膜和内膜之间有裂隙的内膜分离。总之，在两名患者中使用专门设计的导管输送系统和冷却血液灌注液进行激光血管成形术后2周和4周的随访组织学结果显示，动脉血管壁内四分之一有热损伤，且无血栓形成的证据。
