Human percutaneous and intraoperative laser thermal angioplasty: initial clinical results as an adjunct to balloon angioplasty

In this study, the safety and efficacy of percutaneous laser thermal angioplasty as an adjunct to balloon angioplasty were investigated in 13 patients with severe peripheral vascular disease. By means of a novel fiberoptic laser delivery system (Laserprobe) in which argon laser energy is converted to heat in a metallic tip at the end of the fiberoptic fiber, improvement in the angiographic luminal diameter was noted in 14 of 15 femoropopliteal vessels (93%) by delivering 8 to 13 watts of continuous argon laser energy as the Laserprobe was advanced through the lesion. Initial clinical success (indicated by relief of symptoms and increase in Doppler index) for the combined laser and balloon angioplasty procedures was obtained in 12 of 15 vessels (80%), with inadequate balloon dilatation being the limiting factor in three patients. No significant complications of vessel perforation, dissection, pain, spasm, or embolization of debris occurred. Of the 12 patients who had procedures with initial angiographic and clinical success, 10 (83%) were asymptomatic in the initial follow-up period of 1 to 9 months (mean 6 months). Thus, laser thermal angioplasty with a Laserprobe is a safe and effective adjunct to peripheral balloon angioplasty. This technique has the potential to increase the initial success rate of angioplasty for lesions that are difficult or impossible to treat by conventional means. By removing most of the obstructing lesion, this technique may also reduce recurrent stenosis.