Percutaneous excimer laser coronary angioplasty: development of technology and initial clinical results
The development of laser systems suitable for vascular angioplasty is a multidisciplinary endeavor that includes development of the laser energy source, guidance modality, delivery catheter, and assessment of clinical applicability. In this paper we report on the design criteria of percutaneous coronary catheters and how these have guided development of the Spectranetics excimer laser angioplasty system. The Spectranetics CVX-300TM excimer laser angioplasty system was designed for safe application in the cardiac catheterization laboratory while maximizing system maintenance intervals. Recent improvements in catheter design and construction have been directed at optimizing target lesion acquisition and treatment. Lesion access and alignment have been facilitated through the use of optical fiber bundles with increased flexibility. Ablation efficiency has been improved by a combination of increased active fiber area and optimization of the radial location of the fiber array compared to the original devices. Engineered stiffness profiles have been improved and lubricous coatings incorporated to optimize force transmission and tactile feedback for the clinician. Initial clinical results appear favorable. In particular, excimer laser angioplasty appears to have an advantage in the treatment of complex coronary lesions such as diffuse coronary arterial disease, total occlusions, ostial stenoses, moderately calcified lesions, and vein graft disease. In these settings, improved procedural success rates and a lowered incidence of complications have been observed compared to conventional balloon PTCA angioplasty. Examples of complex coronary lesion cases as well as a summary of the data of the initial clinical results from the multicenter trial are also presented in this paper.
Tcheng, JE; Miller, JS; Songer, RW; Golobic, RA
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