Coronary artery thermal damage during percutaneous “hot tip” laser-assisted angioplasty

A major postulated advantage of laser angioplasty as an alternative treatment for occlusive vascular disease is its ability to vaporize obstructive atheroma. 1,2 The bare fiber systems used initially in the peripheral vasculature were able to traverse occlusions but the channels produced were small, subsequent balloon dilatation was always necessary and a high perforation rate was noted. 3 The “hot tip” laser thermal probe produced by encasing the bare fiber tip in a metal cap 4 overcame some of these limitations. The relatively large, smooth and oval metal cap enhanced coaxial placement while localization of all the laser energy (by heat conversion) at the tip made perforations infrequent. 5,6 In the periphery this device recanalized lesions previously impassable to a guidewire and balloon system. 7 For intracoronary use the smaller peripheral artery probes (1.5 to 1.7 mm tips) were modified to include an eccentric guidewire channel through the tip to facilitate coaxial advancement and subsequent balloon exchange. Percutaneous use of this probe in coronary artery disease has produced mixed results. 8–10 In this report we present experience using a more flexible laser thermal device.