Efficient debulking with minimal vascular damage in excimer laser coronary angioplasty

Present day XeCI excimer laser coronary angioplasty (ELCA) with multifiber catheters is a safe and efficacious therapeutic modality. However, ELCA related complications, such as perforation, acute closure and arterial wall dissection, have been reported. These complications are at least partly attributed to vascular wall damage inflicted by fast expanding water vapor bubbles and insoluble gas induced by excimer laser pulses. It has been shown that the single pulse fluence threshold for the formation of a fast expanding bubble is about 20 mJ/mm2. Also, it has been observed that the gas yield increases sharply above 30 mJ/mm2. Therefore, it is conceivable that the vascular damage in ELCA caused by fast expanding bubbles and the accumulation of insoluble gas may be reduced by reducing the size and strength of the fast expanding bubbles and the gas yield by using fluences below 20 mJ/mm2.