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Abrupt Closure After Pulsed Laser Angioplasty: Spasm or A “Mille‐Feuilles” Effect?

Abrupt Closure After Pulsed Laser Angioplasty: Spasm or A “Mille‐Feuilles” Effect? Many interventionalists have debated the etiology of abrupt closure and dissections frequently seen immediately following laser angioplasty . This has been attributed to coronary spasm, however, this event usually does not respond to intracoronary nitrates and is only relieved with balloon angioplasty (Fig. l ) . Recent knowledge acquired about the generation of shock waves in the bathing medium and the arterial wall suggests that abrupt closure following pulsed laser may be a result of a specific type of tissue injury. This injury has the appearance of multiple dissection planes and separation of the layers of the arterial wall, which is similar to the layers seen in the French pastry called “mille-feuilles” or “thousand leaves.” Several reports in this issue are dedicated to laser angioplasty . These reports describe the procedure and the potential advantages of excimer (308 nm) and holmium-YAG (Ho:YAG; 2,100 nm) lasers when compared as an alternative or adjunct technique to balloon angioplasty. In the mid- 1980s pulsed lasers replaced continuous wave (CW) or thermal systems for coronary angioplasty. This was based on the cleaner plaque ablation produced by pulsed lasers as compared to the uncontrolled thermal injury seen with CW lasers.’ It was further http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Journal of Interventional Cardiology Wiley

Abrupt Closure After Pulsed Laser Angioplasty: Spasm or A “Mille‐Feuilles” Effect?

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References (7)

Publisher
Wiley
Copyright
Copyright © 1992 Wiley Subscription Services, Inc., A Wiley Company
ISSN
0896-4327
eISSN
1540-8183
DOI
10.1111/j.1540-8183.1992.tb00830.x
Publisher site
See Article on Publisher Site

Abstract

Many interventionalists have debated the etiology of abrupt closure and dissections frequently seen immediately following laser angioplasty . This has been attributed to coronary spasm, however, this event usually does not respond to intracoronary nitrates and is only relieved with balloon angioplasty (Fig. l ) . Recent knowledge acquired about the generation of shock waves in the bathing medium and the arterial wall suggests that abrupt closure following pulsed laser may be a result of a specific type of tissue injury. This injury has the appearance of multiple dissection planes and separation of the layers of the arterial wall, which is similar to the layers seen in the French pastry called “mille-feuilles” or “thousand leaves.” Several reports in this issue are dedicated to laser angioplasty . These reports describe the procedure and the potential advantages of excimer (308 nm) and holmium-YAG (Ho:YAG; 2,100 nm) lasers when compared as an alternative or adjunct technique to balloon angioplasty. In the mid- 1980s pulsed lasers replaced continuous wave (CW) or thermal systems for coronary angioplasty. This was based on the cleaner plaque ablation produced by pulsed lasers as compared to the uncontrolled thermal injury seen with CW lasers.’ It was further

Journal

Journal of Interventional CardiologyWiley

Published: Dec 1, 1992

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