Hot-tip laser angioplasty: a review of the Texas Heart Institute experience.

At the Texas Heart Institute, from October 1986 to October 1988, laser thermal angioplasty was used in conjunction with balloon angioplasty for treatment of 201 atherosclerotic vascular lesions in 162 patients. All patients had significant symptoms or impending limb loss. Most of the occlusions (148) were located in the superficial femoral artery; the clinical success rate in those cases was 80%. Similar success rates were noted in 25 iliac occlusions (77%) and 16 popliteal occlusions (88%). A small number of tibial vessels were also reopened successfully. Analysis of the results showed a correlation between success rates and lesion length. The success rate dropped from 79% for occlusions that were 10 cm and shorter, to 56% for occlusions ranging from 11 to 20 cm, and to 55% for occlusions longer than 20 cm. The incidence of perforations in most laser series is reflective of operator experience. Perforations occurred in 19 of 90 vessels (21%) in the 1st year of our experience and in 3 of 111 vessels (2.7%) in the 2nd year. Other complications included groin hematomas in 2 patients and embolization to the trifurcation vessels in 4. One patient died 8 hours after the procedure of complications unrelated to laser angioplasty. The safety and efficacy of "hot-tip" laser recanalization in the peripheral vasculature have been proved in early clinical experience. Some preliminary investigations have shown that laser-probe applications may be feasible in the coronary vasculature as well. Future applications of laser systems will depend on their proven ability to reduce restenosis rates and to reliably recanalize totally occluded vessels.