The ultraviolet pulsed
excimer laser (308 nm wavelength) is currently the only
laser approved by the FDA for percutaneous intervention in patients with ischemic
coronary artery disease. The clinical presentation of the treated patients varies from stable and
unstable angina to acute
myocardial infarction. Potential advantages of
excimer laser revascularisation in
acute coronary syndromes and in ischaemic obstructive
peripheral vascular disease include concomitant plaque debulking and
thrombus removal; absence of systemic lytic state; shortened
thrombus clearing time and facilitation of adjunct balloon angioplasty and stenting. Improved understanding of
laser-tissue interactions and positive clinical outcomes through the use of safe lasing techniques have led to expansion of indications/applications for laser angioplasty. These include
stent restenosis, complex lesions and thrombotic
stenoses, bifurcation lesions, balloon failure, total occlusions, focal saphenous vein graft lesions and peripheral arterial obstructions. The
excimer laser can be effectively utilised in patients with depressed left ventricular ejection fraction and does not require implantation of a temporary pacemaker as
no-reflow phenomenon and severe arrhythmias are rarely encountered. Careful case selection, proper utilisation of equipment and incorporation of efficient lasing techniques play a crucial role in effective and safe cardiovascular
laser applications.