Mahmood Mirhoseini

Direct Myocardial Revascularization: Preliminary Experience

It is estimated that in excess of 4,500,000 people in the United States have a history of myocardial infarction or currently have angina. Myocardial infarction is the leading cause of death in America with over 500,000 deaths each year. Important advances have been made in preventing and treating atherosclerotic cardiovascular disease, in preventing premature death, and in reducing disability rates. Despite these efforts, coronary artery disease continues to be a major health problem in this country.

A Clinician's Overview of Laser Systems for Cardiovascular Applications

This paper discusses the current lasers used in cardiovascular applications and presents an overview on function, characteristics, and tissue interactions of the principal lasers used in this field. The discussion includes the lasers and delivery systems currently in use, or with potential future application, for laser angioplasty and laser recanalization. Included are low-intensity laser as well as high-power laser applications.

Technical considerations and factors that influence the outcome of laser-assisted angioplasty.

In the last several years many studies have been conducted to evaluate the feasibility of laser-assisted angioplasty procedures as a therapeutic option for the treatment of patients with peripheral vascular disease. Assessing patient outcomes from studies done at various centers is complicated by the number of variables in patient selection, technical aspects of the procedures, laser parameters, and followup procedures. An ongoing process of defining and refining important parameters and aspects of these procedures is evolving. Important components in achieving good long-term results are technical dexterity with catheter systems, knowledge of angiography techniques, in-depth knowledge in the evaluation and treatment of patients with peripheral vascular disease, and a thorough understanding of laser biophysics and tissue interactions. The importance of technical details as a determinant of successful outcome in the treatment of these patients is discussed. Percutaneous vascular access is the method of choice for angioplasty procedures, but about 36% of patients will require surgical exposure of the femoral artery and possibly endarterectomy of patchplasty. In 11% of patients, the intraluminal channel is inadequate, revascularization is incomplete, or for other technical reasons surgical bypass is necessary. Peripheral laser-assisted angioplasty is a viable treatment alternative in selected patients. As the technique matures the value of its role in the therapeutic armamentarium will emerge.