Intraoperative Coronary Laser Recanalization: Evaluation of Safety in Ten Patients

Abstract

Ten coronary artery bypass candi dates were selected to participate in a phase I evaluation of the safety of a 1.7-mm argon-powered, metal- tipped, fiberoptic laser probe for re canalization of the coronary arteries.

Eleven arteries were selected for lasing based on their inability to jeop ardize the scheduled revasculariza tion procedure. Through an arteriotomy distal to the lesion (or through the distal anastomosis of the bypass graft), the laser probe, at power levels of 10-12 watts, was visu ally monitored for passage across the lesion. Single or multiple pulses of energy were delivered to the tip for from 3- to 23-second intervals, with total lasing times of 9 to 173 seconds.

The probe traversed the lesions in 7 (64%) arteries; the remaining 4 (36%) were totally occluded lesions that blocked entry of the probe in 1 and allowed only minimal penetra tion in 3 others. In 1, the distal tip fractured after becoming lodged in the plaque. There was no perfora tion, dissection, or other complica tion to the lasing procedure in this series. One patient died from an un related acute myocardial infarction occurring four days postoperatively.

Calcified plaques pose a major problem for this probe design, but it appears to safely open channels in less mature plaques. Phase II of the study will investigate the efficacy of laser-assisted myocardial revascular ization.