Experimental and clinical angioplasty with a laser probe fiberoptic catheter system.

The ablation of atherosclerotic tissue by laser energy was a promising new idea in the treatment of atherosclerotic vascular diseases. Initial studies showed a lot of beneficial effects but also a lot of complications like perforations and thermal injuries. The introduction of a new fiber optic system with a metalcapped quartzfiber, changing the laser energy into thermal energy, showed significant improvements. First animal studies revealed a higher success rate and a significantly decreased risk of perforation. Based on these results first clinical studies in the femoro-popliteal region were started. Meanwhile 129 patients with stenoses or occlusions of the femoral arteries have been treated with this new fiber optic system under fluoroscopic control. Patency rate was 93% for stenoses and 89% for total occlusions. In all cases the procedure was completed by a balloon angioplasty. Reinvestigations revealed a cumulative one-year-patency rate of 77%. This is well comparable to long-term results of balloon angioplasty. First clinical applications of this so called "hot-tip" in coronary arteries proved the possibility of reopening stenoses or occlusions in the small vessels. Still further improvements in flexibility and steerability of the catheter systems have to be made, before this method can become routine too. By further improvement laser angioplasty will find its place besides balloon angioplasty and surgery in the treatment of the atherosclerotic vascular disease.