title: Development of a new technique for reducing pressure pulse generation during 308-nm excimer laser coronary angioplasty.
abstract: Despite expectations that excimer laser ablation would result in a low incidence of coronary dissection, studies have documented a 15-20% incidence of dissection (including a 4-6% incidence of clinically significant dissection) during excimer interventions. This investigation sought to determine if pressure pulses produced by the exposure of fluid phase media (blood and contrast) to 308-nm excimer radiation might contribute to untoward outcomes. Pressure pulses generated in these media were quantitated to be > 100 atm. In vitro ablation of porcine aorta in the presence of blood or contrast resulted in tissue dissection, while ablation in pure crystalloid did not. Next, a "flush and bathe" technique designed to replace all blood and contrast with crystalloid was applied to a pilot population of 57 consecutive patients. There were no rhythm disturbances or laser-related clinically significant dissections in this group, and the clinical success rate was 95%. In summary, this report quantitates a potential etiology for excimer dissection and suggests that replacement of blood and contrast with crystalloid might improve procedural and clinical success rates.
authors.affiliation: Department of Medicine, Duke University Medical Center, Durham, North Carolina 27710, USA.
authors.forename: J E
authors.initials: JE
authors.lastname: Tcheng
authors.forename: L D
authors.initials: LD
authors.lastname: Wells
authors.forename: H R
authors.initials: HR
authors.lastname: Phillips
authors.forename: L I
authors.initials: LI
authors.lastname: Deckelbaum
authors.forename: R A
authors.initials: RA
authors.lastname: Golobic
mesh_terms: D016342:Angioplasty, Laser / Q000009:adverse effects* / Q000295:instrumentation* / Q000379:methods; D000818:Animals; D003327:Coronary Disease / Q000601:surgery*; D003331:Coronary Vessels / Q000528:radiation effects*; D004869:Equipment Safety; D006801:Humans; D066298:In Vitro Techniques; D010865:Pilot Projects; D013552:Swine