Argon laser-induced arterial photothrombosis. Characterization and possible application to therapy of arteriovenous malformations.

The common carotid, femoral, and middle cerebral arteries in the rat have been occluded thrombotically by means of a rose bengal dye-sensitized photochemical reaction initiated in vascular endothelium by the 514.5-nm beam of an argon laser, focused for maximum excitation efficiency of the photosensitizer according to a derived criterion. The total energy required for vessel occlusion was approximately 1 joule (J) for the middle cerebral artery and 140 to 180 J for the femoral and carotid arteries. At energy fluences (energy deposited per unit area) of 3.5 kJ/sq cm for the middle cerebral artery and 35 kJ/sq cm for the larger arteries, occlusion was observed within 3 minutes. The middle cerebral artery thrombus consisted entirely of aggregated platelets; in the larger arteries the thrombi were composed of platelet aggregates and groups of red blood cells interspersed within a matrix of coagulum. Vessels irradiated similarly in the absence of rose bengal dye displayed no morphological or functional damage. Because the photochemical reaction is mediated by electronic-state transitions, the process of photothrombosis (as opposed to photocoagulation) can be initiated in vessels with high flow rates without the requirement of increased temperature. The photothrombotic technique may be useful in the treatment of arteriovenous malformations owing to its significant enhancement of the efficiency and permanency of vessel occlusion.