[How far has laser angioplasty gotten?].
Several clinical trials of laser angioplasty performed on peripheral arteries have demonstrated that continuous lasers are capable of repermeabilize occluded arteries, with a low complication rate and perhaps a reduced incidence of restenosis, in comparison with balloon angioplasty. However, the mediocre size of the "neo-lumens" created by laser, requires an additional balloon angioplasty. Moreover, a number of drawbacks have been noted: even if they only exceptionally require surgery, perforations are note unusual, emphasizing the importance of an accurate guiding of the laser beam. Besides, histologically, burns of the arterial wall are found constantly along with the related risk of spasm and thrombosis. Finally, very calcified lesions are relatively resistant to these lasers. Pulsed lasers (excimeres lasers, coloring lasers, etc.) allowing a precise excision of atheroma plaques, even calcified, without any major overheating, are currently under experimentation. The clinical experiment of percutaneous application of laser energy to the treatment of coronary atheroma, remains limited and concerns, for the time being, "thermic" angioplasty devices by continuous laser ("hot-tip"). It is possible that in these small caliber vessels, pulse lasers prove to be superior to continuous lasers because of the precision of their excision and the absence of overheating of the surrounding tissues. Several angioplasty systems, competitors of lasers, have recently been developed (atherectomy, drills, radio-frequencies, ultrasounds, etc.) and prove, for some of them, to be easy to use, less expensive than lasers and particularly effective in the treatment of incomplete occlusions, in the peripheral as well as coronary arteries.(ABSTRACT TRUNCATED AT 250 WORDS)
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Service de Cardiologie, Hôpital Bichat, Paris.
D000800:Angioplasty, Balloon / Q000009:adverse effects / Q000379:methods*; D001158:Arteries / Q000293:injuries; D006801:Humans; D053685:Laser Therapy; D007834:Lasers / Q000009:adverse effects
Où en est l'angioplastie laser?