Intravascular ultrasound guided Holmium:YAG laser recanalization of occluded arteries

Rodney A. White, George E. Kopchok, Marwan R. Tabbara, Douglas M. Cavaye, Francois Cormier

Research output: Contribution to journalArticle

13 Scopus citations

Abstract

Current angioplasty devices are limited by arterial wall dissection and perforation, and by early recurrence from inadequate debulking of lesions. This study evaluated intravascular ultrasound (IVUS) as guidance for concentric laser recanalization of arterial occlusions. Twelve, 2-4-cm-long canine iliac artery occlusions were treated at 2 weeks (organizing thrombus) to 12 weeks (firm fibrous lesions) using a Holmium:YAG laser (2,100 nm wavelength) in free running mode, FRM, (250 μsec pulse, 5 Hz), n = 9; and Q- switched mode, QSM (200 ns pulse, 6 Hz), n = 3. A 200 μm (n = 2) or 600 μm (n = 10) optic fiber was centered in the artery coaxial to a 5Fr rotating A scan IVUS probe. The fiber was positioned in the center of the artery distal to the lesion and slowly advanced through the obstruction. In 8 occlusions the same fiber was used as a guidewire for passage of either a 1.6-mm-(n = 2) and/or 3.0-mm (n = 6) diameter multifiber catheter (19 x 100 and 19 x 200 μm fibers, respectively) using FRM energy to further debulk the lesion. In all cases, IVUS guidance enabled concentric initial recanalization of occlusions, although 3 vessel perforations resulted from fiber deviation off the center of the lumen at a distance of 2 to 4 cm from the IVUS imaging element. Both QSM and FRM modes ablated tissue, with FRM modes producing more tissue fragmentation and thermal effect. IVUS images accurately diagnosed the location of lesions compared to angioscopic views and pathologic analysis of the specimens. This study suggests that IVUS guided laser energy may enable initial concentric recanalization of arterial occlusions if adequate tissue removal can be accomplished to provide continuous IVUS imaging as the recanalization proceeds.

Original languageEnglish (US)
Pages (from-to)239-245
Number of pages7
JournalLasers in Surgery and Medicine
Volume12
Issue number3
DOIs
StatePublished - 1992
Externally publishedYes

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Keywords

  • angioplasty
  • endovascular surgery
  • guidance
  • intraluminal ultrasound

ASJC Scopus subject areas

  • Surgery
  • Dermatology

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