Deckelbaum L I
Section of Cardiovascular Disease, West Haven VA Medical Center, Connecticut 06516.
Lasers Surg Med. 1994;14(2):101-10. doi: 10.1002/1096-9101(1994)14:2<101::aid-lsm1900140202>3.0.co;2-l.
With the widespread growth of percutaneous transluminal coronary angioplasty (PTCA), the realization of limitations of balloon angioplasty stimulated the development of alternative revascularization approaches such as laser angioplasty. PTCA is best suited for the treatment of discrete atherosclerotic stenoses, with lower success rates and more difficult application in patients with diffuse atherosclerotic disease or total occlusions [1-3]. Moreover, despite an initially high primary success rate, coronary angioplasty is still plagued by a restenosis rate as high as 57% [4]. The potential advantages of laser angioplasty address the limitations of PTCA. In contrast to balloon angioplasty where the plaque material is compressed or displaced, laser angioplasty ablates the plaque material [5]. This bulk removal of plaque material could improve acute procedural success rates, decrease complication rates, treat "untreatable" lesions, and decrease restenosis rates. Because laser energy can vaporize atherosclerotic plaque, there may be no requirement for a preexisting channel, and therefore laser angioplasty may have a high success rate for the treatment of coronary occlusions. In its best embodiment, laser angioplasty offers the potential for passing a fiberoptic catheter through the entire length of the coronary circulation to vaporize all atherosclerotic plaque along the arterial wall. This applicability for the treatment of diffuse atherosclerotic disease would offer treatment opportunities currently unavailable with conventional bypass surgery or angioplasty.
随着经皮腔内冠状动脉成形术（PTCA）的广泛应用，人们认识到球囊血管成形术的局限性，这刺激了诸如激光血管成形术等替代性血运重建方法的发展。PTCA最适合治疗局限性动脉粥样硬化狭窄，对于弥漫性动脉粥样硬化疾病或完全闭塞的患者，其成功率较低且应用难度更大[1-3]。此外，尽管最初的主要成功率较高，但冠状动脉成形术的再狭窄率仍高达57%[4]。激光血管成形术的潜在优势弥补了PTCA的局限性。与球囊血管成形术通过压缩或移位斑块物质不同，激光血管成形术可消融斑块物质[5]。这种对斑块物质的大量清除可提高手术急性成功率、降低并发症发生率、治疗“无法治疗”的病变并降低再狭窄率。由于激光能量可使动脉粥样硬化斑块汽化，可能无需预先存在通道，因此激光血管成形术治疗冠状动脉闭塞可能具有较高的成功率。在其最佳实施方式中，激光血管成形术有望使光纤导管穿过整个冠状动脉循环长度，以汽化动脉壁上的所有动脉粥样硬化斑块。这种对弥漫性动脉粥样硬化疾病的适用性将提供目前传统搭桥手术或血管成形术无法提供的治疗机会。
