Total peripheral artery occlusions: conventional versus laser thermal recanalization with a hybrid probe in percutaneous angioplasty - results of a randomized trial

Article Abstract:

Percutaneous transluminal angioplasty (PTA) is a procedure to treat occlusions or blockages in peripheral and other arteries. The procedure involves first crossing the blockage, so that a deflated balloon can be passed through it and then inflated to open the vessel further. The initial crossing of the blockage has been traditionally attempted by means of a guide-wire. More recently, the use of lasers to cross the blockage has been introduced. Although a number of reports have stated that lasers are highly effective in cutting through blockages that guide-wires have failed to cross, no randomized clinical trials have been performed to support these claims. To examine this issue, 81 patients with a total of 84 occlusions of the iliac (16 cases) or femoropopliteal (68 cases) arteries (both in the pelvic area or legs) were randomly chosen for treatment with conventional or laser thermal PTA. If the chosen treatment was unsuccessful, the other treatment was then attempted. For the femoropopliteal occlusions, 34 were treated with laser PTA. The occlusion was successfully crossed in 28 cases and the PTA as a whole was considered clinically successful in 27 cases (79 percent). In three of the six cases where the laser failed, a guide-wire was successfully used to cross the occlusion and clinical success was attained in two of those cases. Overall clinical success when both procedures were used was 29 of 34, or 85 percent. Conventional PTA was the initial treatment for the other 34 cases of femoropopliteal occlusion. The guide-wire successfully crossed the occlusion in 25 cases and clinical success was attained in 24 (71 percent) of the cases. Of the other nine cases, the laser probe was able to cross the occlusion in five cases where the laser was not activated. Mechanical rather than laser properties were responsible for successful crossing in these cases. In one case the activated probe crossed the occlusion with some pressure. Clinical success in this group increased to 88 percent. The results showed that initial success in crossing the occlusions was similar for both techniques and that success when using laser probes after a guide-wire has failed to cross the occlusion is often due to mechanical properties. The enthusiastic claims for the superiority of laser over guide-wire PTA appear to be overstated. (Consumer Summary produced by Reliance Medical Information, Inc.)

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Femoropopliteal arterial occlusions: laser-assisted versus conventional percutaneous transluminal angioplasty

Article Abstract:

Percutaneous transluminal angioplasty (PTA) is frequently used in the treatment of arterial blockages. It involves first making a hole in the blockage using a guide-wire or a laser probe. A deflated balloon is then passed through the hole and inflated to further open the blocked portion of the artery. Use of a laser probe for PTA is relatively new and its effectiveness compared with conventional (guide-wire) PTA is unclear. To evaluate this issue, 75 patients with femoropopliteal arterial occlusions were treated with either conventional PTA (28 patients) or laser PTA (47 patients). The lengths of occluded artery averaged 5.5 cm for the conventional group and 11.6 cm for the patients selected for the laser procedure. Of the 28 conventional PTA treatments performed, 21 (75 percent) were successful. The average length of the occlusions in the successfully treated patients was significantly shorter than that of the unsuccessfully treated patients (5.5 cm versus 8.7 cm). Of the 47 laser PTA treatments performed, 32 (68 percent) were successful. There was no significant difference between the average lengths of the occlusions of the patients treated successfully and unsuccessfully with laser PTA. Clinical, as opposed to technical, success was attained for 68 percent of the patients who underwent conventional PTA and 53 percent for those who underwent laser PTA. This was not a significant difference. In the short term, laser PTA appeared to be effective in treating larger arterial occlusions. Further studies on the long term outcomes of treatment with laser PTA are needed. (Consumer Summary produced by Reliance Medical Information, Inc.)

Laser angioplasty

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Vascular interventional radiologists, the development of new technologies, marketing, and the auk

Article Abstract:

Percutaneous transluminal angioplasty (PTA) is a procedure for treating narrowed or blocked blood vessels. Occlusions of the peripheral arteries (outside the trunk) have traditionally been treated with PTA, which involved initially using a guide wire to cross the blockage and then inserting a deflated balloon through the opening created and inflating it to open the vessel further. More recently, lasers have been introduced for use in place of the guide wires to initially open the vessel. In the October 1991 issue of Radiology, a study by Belli compares PTA using a guide wire with that using a laser in the femoropopliteal or the iliac arteries in the legs. Their results showed that the laser was no better than, or not even as good as, the guide wire in crossing the arterial blockages. Other researchers have previously cautioned against rushing to buy expensive laser equipment for PTA when its effectiveness had not been established. The enthusiasm for using lasers for PTA has greatly dropped from its peak of a few years ago. This does not mean that the laser has no use in PTA, it just means that technology has not yet advanced to the point where lasers are effective enough to justify their use. Whether laser technology will ever advance to such a point remains to be seen. (Consumer Summary produced by Reliance Medical Information, Inc.)

editorial

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