Cardiovascular laser application.

With the invention of the laser, many clinical disciplines have taken advantage of this new energy source. Its precision, intensity and energy density is superior to all other known surgical devices. Based on the principle of light amplification from a photon-emitting resonator, the monochromaticity, collimation and coherence provide the high-energy density of the laser beam for medical applications. The state-of-the-art and future potential of laser use in cardiovascular diseases will be reviewed. Most of the work in this field has been accomplished during the past decade with numerous research projects. Although many technical advances have been made, so far the results in cardiovascular medicine are in the areas of vessel anastomosis, ablation of conduction passes for arrhythmia therapy, and angioplasty. In this paper, special attention will be given to the recent success in XeCl excimer laser application for photodecomposition of tissue with a goal of improved recanalization. The high-power density of the XeCl excimer laser provides significant advantages for the disruption of both embolic and calcified plaque. Regardless of the type of tissue ablated, gross, histologic, and ultra-structural analysis confirmed the absence of thermal injury in luminar recanalization as well as in animal studies. Progress in the manufacture of catheters, with multiple very small diameter fibers, led to the decisive breakthrough in clinical laser angioplasty. Peripheral as well as coronary arteries have been successfully recanalized followed by balloon dilatation. The ease of application and the success achieved thus far have resulted in an optimistic assessment for laser medicine.