Author + information
- Received June 13, 1988
- Revision received September 28, 1988
- Accepted January 13, 1989
- Published online June 1, 1989.
- Jonathan Tobis, MD, FACC∗,
- Michael Smolin, MD,
- John Mallery, MD,
- Lachlan Macleay, MD,
- Warren D. Johnston, MD,
- John E. Connolly, MD,
- George Lewis, MD,
- Bob Zuch, MD,
- Walter Henry, MD, FACC and
- Michael Berns, PhD
- ↵∗Address for reprints: Jonathan Tobis, MD, Division of Cardiology, Route 81, University of California, Irvine Medical Center, 101 The City Drive, Orange, California 92668.
Recanalization of completely occluded superficial femoral or popliteal arteries was attempted in 18 patients with use of an Argon laser-mediated thermal probe. The length of the occluded segments varied between 0.5 and 26.0 cm, but 67% of the occlusions were >9 cm long. The initial success rate was 67%. Arterial perforation occurred in six patients but was not associated with major complications.
To study the mechanism of the laser-mediated thermal probe, thermal recanalization was performed on 11 human arterial segments in vitro obtained after amputation, and mechanical recanalization was performed in vitro in 10 human peripheral arteries with use of a guide wire and catheter technique. An additional four arteries were studied with the laser probe as a non-heated mechanical device. Both the mechanical and thermal devices appear to follow a similar pathway through a complete obstruction. These studies suggest that the thermal probe burns through soft fibrous tissue but is mechanically deflected away from hard fibrocalcific plaque. The probe then advances along the plane between the intimal plaque and the media for a variable length before perforating through the adventitia.
These observations suggest that the major mechanism of thermal probe recanalization may be a mechanical process. It appears that thermal probe devices do not inherently seek the true lumen of an occluded artery and that better guidance systems need to be developed.
☆ This study was supported in part by Grant 2R01 HL 31318-04 from the National Institutes of Health, Bethesda, Maryland.
- Received June 13, 1988.
- Revision received September 28, 1988.
- Accepted January 13, 1989.