Laser Recanalization of Thrombosed Arteries Using Thermal and/or Modified Optical Probes;Angiographic and Angioscopic Study

Abstract

The degree of residual stenosis by fresh thrombus after laser recanalization was compared by use of angiography and angioscopy. Fifteen NZW rabbits were used. Occlusive fresh thrombus in rabbit aorta was produced by mechani cal deendothelialization and external constrictions simulating clinical situations. Argon laser angioplasty using microlens-tipped optical fiber and/or 2 mm hot- tip probe was done to recanalize thrombosed aorta in 10 animals. Two-mm hybrid probe was used in 5. Percent area stenosis (% AST) was derived by use of the mean radius method obtained by angiography of stenotic segments in two orthogonal views and/or from angioscopy. All 15 totally occluded vessels with fresh thrombus were recanalized. Four minor perforations occurred.

Following argon laser angioplasty with the microlens optical fiber, percent stenosis was reduced to 53% in diameter by angiography and 66 in % AST by angioscopy, and to 48% and 55 respectively following hot-tip probe. After laser angioplasty with the hybrid probe, residual stenosis by fresh thrombus was 37% in diameter on angiography and 63 in % AST on angioscopy. Mean percent AST was 62% with angiography and 52% with angioscopy, and there was no correla tion between them (r =-0.028). Angioscopy provided cross-sectional topo graphic views of thrombosed lumen and showed charring and shrinkage of thrombus following laser angioplasty.

This study suggests that (1) continuous-wave laser angioplasty using modi fied optical fibers can recanalize thrombotic vascular occlusion, (2) laser angio plasty by hop-tip probe could evacuate fresh thrombus more than microlens fiber on angioscopy, and (3) angiographic % AST did not correlate with angio scopic % AST.