Author + information
- Received February 4, 1986
- Revision received May 28, 1986
- Accepted June 6, 1986
- Published online November 1, 1986.
- Herbert Geschwind, MD, FACC*,α,
- Monique Fabre, MD†,
- Bernard R. Chaitman, MD, FACC*,
- Marc Lefebvre-Villardebo, MD‡,
- Aliette Ladouch, MD†,
- Georges Boussignac, MD‡,
- John D. Blair, MD* and
- Harold L. Kennedy, MD, FACC*
- ↵αAddress for reprints: Herbert Geschwind, MD, St. Louis University Medical School, 1325 South Grand Boulevard, Department of Cardiology, 11-FDH, St. Louis, Missouri 63104.
Laser recanalization of occluded femoral or popliteal arteries was performed in 12 patients using a continuous wave neodymium yttrium aluminum garnet (Nd-YAG) laser. The histologic findings of the laser-irradiated arterial segments in two of these patients are reported. The specimens were obtained 2 and 4 weeks after the laser procedure. The laser-irradiated vessel in Patient 1 had been partially recanalized with reduction of the atherosclerotic occlusion from 3 to 1 cm. The lased arterial lumen manifested thermal injury to the inner quarter of the arterial wall with vacuolization and a rim of carbonization occupying 10% of the width of the arterial wall, but without thrombus formation.
Histologic examination in Patient 2 revealed no fibrin deposits, atherosclerotic debris or thrombi at the intimai arterial edge. At the crater site, thermal injury was apparent with vacuolization of the intimai fibrous tissue. The histologic sections obtained 4 weeks after the procedure revealed new fibrous intimai tissue without en-dothelialization in some of the heavily calcified tissue sections. Where the plaques were noncalcified, reen-dothelialization was noted with only minimal damage to the surrounding tissue. No medial or elastic fiber disruption was seen, and no aneurysmal dilation had occurred. Intimai splitting with a cleft betwen the tunica media and the intima was noted at the site of previous balloon angioplasty.
In conclusion, the follow-up histologic findings 2 and 4 weeks after laser angioplasty in two patients using a specially designed catheter delivery system and cooling blood perfusate revealed thermal injury to the inner quarter of the arterial vessel wall and no evidence of thrombus formation.
- Received February 4, 1986.
- Revision received May 28, 1986.
- Accepted June 6, 1986.
- American College of Cardiology Foundation