Excimer laser (308 nm) recanalisation of in-stent restenosis: thermal considerations.

Excimer laser recanalisation of in-stent restenosis may be a viable modality for improving coronary patency. However, the presence of arterial stents modifies the thermal properties of the irradiated area and may alter temperature patterns generated during ablation. The goal of this study was to evaluate, in vitro, temperature changes during excimer laser ablation of stented vessels and compare them with those obtained from unstented (control) vessels. Six different stent types (AVE Microstent-II, AVE-GFX, ACS Multi-link, JJ Palmaz-Schatz, JJ Crown, and NIR) were deployed in freshly excised porcine coronary vessels. Three control unstented samples were also measured. Blood or saline was infused through the vessels, while the tissue environment was kept at approximately 37 degrees C. A 308 nm excimer laser (Spectranetics, CVX300) with an eccentric 2.0 mm laser catheter (Spectranetics, EII) delivered two trains of 200 pulses each, 10 s apart, at 60 mJ/mm2, and 40 Hz, simulating maximum clinical exposure. The catheter was positioned midway in the stent, first coaxially parallel to the vessel wall, and then at an angle against the stent and vessel wall. Temperature measurements (n= 168 for blood, n=96 for saline) were performed with a approximately 210 microm diameter, fast-response thermocouple with 0.1 degrees C resolution. The probe was positioned to within approximately 250 microm from the inner surface of the vessels. Tissue temperature was measured at the catheter tip and at the distal and proximal edges of the stents. Maximum recorded temperatures for coaxial and angular alignment, did not exceed 42.2 degrees C (approximately 6 degrees C above baseline) and 54.2 degrees C (approximately 18.1 degrees C above baseline) respectively, for all stents types tested, controls, and all probe locations. Both stented and unstented vessels exhibited comparable temperature gradients. The observed maximum temperatures, obtained under extreme lasing conditions, indicated that 308 nm ablation, in the presence of stents under blood or saline infusion, produces clinically acceptable temperatures.

Excimer laser (308 nm) based transmyocardial laser revascularization: effects of the lasing parameters on myocardial histology.

BACKGROUND AND OBJECTIVE: The effect of the excimer laser (308 nm) parameters on transmyocardial revascularization (TMR) channels is not well defined. This study investigates the influence of the pulse repetition rate, the size of the delivery catheter and its advancement speed on the morphology of TMR channels in vivo. STUDY DESIGN/MATERIALS AND METHODS: Myocardial ablation was performed in a porcine model (N = 27) using multifiber catheters of 1.0 and 1.4 mm in diameter. The catheters were advanced into the myocardium at different speeds (1.27 and 2.54 mm/sec) while ablating at various repetition rates (10-80 Hz). The radiant exposure was kept at 35 mJ/mm(2) throughout the experiments. The channel histology was quantified by digital microscopy. RESULTS: The channel cross-sectional area and the extent of the thermal damage decrease as the catheter advancement speed exceeds the ablation speed and vice versa. Within the parameters tested, advancement speed of about 1.3 mm/sec and pulse repetition rates of 40 Hz produce channels of size comparable to the catheter's diameter with moderate thermomechanical damage. CONCLUSIONS: The repetition rate, catheter size, and catheter advancement speed are closely intertwined and crucial to the histological outcome of excimer laser based TMR.

Laser tissue interaction in direct myocardial revascularization.

This investigation examines the various laser choices used for transmyocardial laser revascularization (TMLR) with emphasis on the laser-tissue interaction. A series of in vivo (porcine model, n=27) and in vitro experiments were performed to study the effects of CO(2), holmium:YAG, and XeCl excimer lasers on the histological outcome of TMR channels. Computerized histopathological analysis has revealed that the CO(2) and holmium:YAG lasers produce substantial unpredictable thermal damage and differ predominantly in the amount of the mechanical injury or tissue shredding. In comparison, the excimer laser appears to produce the most uniform tissue ablation with the least thermal and shockwave damage.

Laser induced fluorescence attenuation spectroscopy: detection of hypoxia.

The development of a new laser-induced fluorescence (LIF) spectroscopy technique for the measurement of the attenuation spectrum of tissue is described. The technique, termed laser-induced fluorescence attenuation spectroscopy (LIFAS), has been applied to study the effects of hypoxia on the in vivo optical properties of renal and myocardial tissue in the 350-600-nm band. Excimer laser (Xe-Cl) is used to excite a small volume of the tissue (rabbit model, N = 20) and induce autofluorescence. The emitted LIF is monitored fiberoptically at two locations that are unevenly displaced about the fluorescing volume. The optical attenuation of the tissue is calculated from the dual LIF measurements by assuming an exponential decay of the fluorescence with distance. The results indicate that hypoxia modulates the attenuation spectrum leading to characteristic changes in its shape. Primarily, the spectral profile becomes more concave between 455 nm and 505 nm and two spectral peaks at about 540 and 580 nm disappear leaving in their place a single peak at about 555 nm. The attenuation spectra of normoxic and hypoxic tissue are used to train partial least squares multivariate model for spectral classification. The model detected acute renal and myocardial hypoxia with an accuracy greater than 90% (range: 90%-96%) and 74% (range: 74%-90%), respectively.

Aggregation effects in whole blood: influence of time and shear rate measured using ultrasound.

Ultrasound B-mode imaging (7 MHz) was used to measure blood echogenicity and velocity profiles simultaneously as they developed with axial distance for a steady flow of 28% hematocrit whole blood flowing in a long (> 60 D) large diameter (D = 2.54 cm) tube. At selected sites along the flow axis, velocity profiles were measured using block matching (cross correlation) between successive digitized images with a known time separation; from these shear rate profiles were calculated. The corresponding echogenicity profiles were also determined by averaging the digitized images. It was found that over a range of low shear rates, the echogenicity is enhanced in a manner similar to the previously reported influence on aggregation. Evidence is presented confirming the important role of aggregation in controlling the echogenicity. The transient effects of abrupt flow stoppage were studied and shown to provide useful insights into aggregation kinetics. Based on the above results, a detailed explanation is provided of the echogenicity variations seen in B-mode ultrasound images of slow-moving blood.

Three-dimensional display of calculated velocity profiles for physiological flow waveforms.

PURPOSE: To improve the understanding of the nature of pulsatile flow, three-dimensional idealized velocity profiles corresponding to measured physiological mean flow velocity waveforms were displayed at selected instants throughout the flow cycle. METHODS: The Fourier harmonics for each waveform were determined, and their corresponding velocity profiles at each instant of time were calculated with the Womersley equations. Velocity profiles were calculated by summing the contributions from each harmonic. RESULTS: Calculated profiles were displayed in a three-dimensional perspective for both normal carotid and femoral arteries and for simple sinusoidal flow with a superimposed steady component. CONCLUSION: The potential value of such displays is discussed in terms of gaining an improved understanding of the nature of pulsatile flow and clarifying the interpretation of Doppler ultrasound recordings.