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Online ISSN 1827-1847
Barshes N. R. 1, Zhou W. 2
1 Michael E. DeBakey Department of Surgery Baylor College of Medicine, Houston, TX, USA
2 Department of Surgery Stanford University, Palo Alto, CA, USA
Laser atherectomy refers to the use of laser energy to ablate occlusive atheromatous arterial occlusions. First applied to vascular lesions in 1963, clinical laser atherectomy and the fundamental interaction between lasers and vascular tissue have since been extensively studied. Lasers exert an ablative effect on blood vessel walls via photothermal, photochemical and photomechanical effects. While photothermal effects predominate, photomechanical effects may be responsible for dissection of the vessel wall, a known complication of laser atherectomy. Randomized and non-randomized studies of both using laser atherectomy combined with balloon angioplasty as well as using laser atherectomy as “sole therapy” (i.e. not accompanied by balloon angioplasty) have shown high rates of technical success but equivocal long-term patency rate to that of balloon angioplasty. Nonetheless, laser atherectomy may have a role as an adjunctive treatment option for occlusive lesions that cannot be crossed with a guidewire or a balloon angioplasty catheter. Although further refinement of the laser devices is underway, laser atherectomy deserves a place in the armamentarium of the contemporary vascular surgeons and peripheral interventionists.