Role of laser and thermal ablation devices in the treatment of vascular diseases

Since the first coronary angioplasty in 1977, both the number and complexity of interventional procedures have grown dramatically. Continuous-wave and pulsed lasers may further extend the capabilities of balloon angioplasty. Fiberoptic catheters may be used to transmit continuous-wave laser energy to ablate plaque via thermal mechanisms. Pulsed laser systems (such as the excimer) are technologically more complex than the continuous-wave systems, but may prove superior in small vessels given their ability to ablate plaque with minimal associated effects. On the other hand, modifications of the fiberoptic tip, such as the placement of a metal cap, have yielded even better results than current bare fiber systems. Such laser thermal techniques have proved a useful adjunct to balloon dilatation in peripheral vessels, but further research is necessary to determine their effect on coronary arteries. New, nonlaser technologies, however, may provide simpler power sources for thermal angioplasty. Although balloon angioplasty remains the cornerstone of interventional vascular therapy, new technologies should help to further expand the indications for nonsurgical interventions.