Laser

The first medical application of laser was reported by Dr Leon Goldman who, in 1962, reported the use of ruby and carbon dioxide (CO2) lasers in dermatology. In cardiovascular disease, early laser use was confined to cadaver vessels, animal models, and arteries located in freshly amputated limbs, until eventually work progressed to the use of laser energy to salvage an ischaemic limb in 1984. The concept of using laser to remove atherosclerotic material in coronary arteries developed as an alternative strategy to simply modifying the shape of an obstructed lumen as occurs with simple balloon angioplasty. Expectations grew that this new biomedical technology may overcome the low success rate and high complication rate of lesions considered non-ideal for balloon angioplasty. However, initial successful reports could not be replicated. Furthermore, underdeveloped catheter technology and limited appreciation of laser/tissue interactions meant that a cure for restenosis was not in fact discovered and laser coronary angioplasty became isolated to only a few centres in the world. However, more recently with advancement in both catheter technology and technique, excimer coronary laser angioplasty (ELCA) has been rediscovered for use in specific subsets of percutaneous coronary interventions (PCIs). This chapter outlines the basic principles of ELCA and important practical aspects for using the device in contemporary PCI. A discussion of the current indications for clinical use follows and these are highlighted by clinical case examples.