Strauer B E, Neubaur T, Klepzig M, Heintzen M, Zeitler E, Richter E I
Medizinische Klinik und Poliklinik B, Universität Düsseldorf.
Z Kardiol. 1988 Jan;77(1):29-35.
Laser angioplasty has developed as a new method for the treatment of peripheral arterial occlusive disease. In 19 patients with high grade stenoses or obstructions of the superficial femoral, popliteal or posterior tibial arteries (Fontaine stage IIa-IV) percutaneous transluminal laser angioplasty was performed using a novel laser catheter system. The laser catheter itself is made of polyethylene. Its distal tip is formed ovally and marked X-ray densely. A silica fiber (core diameter 0.6 mm) for delivering the laser energy is inserted into the laser catheter. Through a sheath with hemostatic valve, laser catheter and silica fiber are introduced into the artery and then advanced to the stenosis over a guide wire. During laser angioplasty, laser catheter and silica fiber are rotated around the guide wire. We use a cw-Nd: YAG laser with a wavelength of 1064 nm. The mean degree of stenosis decreased from 92 +/- 12% before to 31 +/- 19% after laser angioplasty. By conventional balloon angioplasty a further reduction of the degree of stenosis down to 15 +/- 20% was achieved. The mean systolic Doppler ankle-arm pressure ratio improved from 0.56 +/- 0.25 before laser angioplasty to 0.89 +/- 0.24 after combined laser and balloon angioplasty. In seven patients, clinically non-significant distal embolization occurred. In no patient there was a perforation of the arterial wall. Up to now, digital subtraction angiography 3 months after laser angioplasty has been performed in five patients and showed patency of all lesions. The mean systolic Doppler ankle-arm pressure ratio was 0.84 +/- 0.20.
激光血管成形术已发展成为一种治疗周围动脉闭塞性疾病的新方法。对19例患有股浅动脉、腘动脉或胫后动脉高度狭窄或阻塞（Fontaine分期IIa-IV期）的患者，使用一种新型激光导管系统进行经皮腔内激光血管成形术。激光导管本身由聚乙烯制成。其远端呈椭圆形，在X射线下显影浓密。一根用于传输激光能量的石英光纤（芯径0.6毫米）插入激光导管。通过带有止血阀的鞘管，将激光导管和石英光纤引入动脉，然后在导丝引导下推进至狭窄部位。在激光血管成形术过程中，激光导管和石英光纤围绕导丝旋转。我们使用波长为1064纳米的连续波钕:钇铝石榴石激光。狭窄平均程度从激光血管成形术前的92±12%降至术后的31±19%。通过传统球囊血管成形术，狭窄程度进一步降至15±20%。平均收缩期多普勒踝臂压力比从激光血管成形术前的0.56±0.25提高到联合激光和球囊血管成形术后的0.89±0.24。7例患者发生临床上无显著意义的远端栓塞。无患者出现动脉壁穿孔。到目前为止，已对5例患者在激光血管成形术后3个月进行了数字减影血管造影，结果显示所有病变均通畅。平均收缩期多普勒踝臂压力比为0.84±0.20。
