In recent years, rapid progress in the application of
lasers to the percutaneous treatment of
atherosclerosis has been made. An overview of this progress is provided herein in terms of a description of promising
laser approaches and problems to be solved. Direct vaporization of obstructing
atheroma with fiberoptic delivery of
laser energy has been associated with a high incidence of mural perforation, but each of a variety of techniques, including those for improved energy delivery, plaque recognition, alignment of the fiberoptic, and, perhaps, reduction of unnecessary thermal injury, has shown promise for reducing this complication. Nonablation applications of
laser energy may also have a role in the treatment of
atherosclerosis. During laser balloon angioplasty, the tissue coagulation effects of
laser-thermal energy may be used during balloon inflation to eliminate
arterial dissections and to reduce elastic recoil, thereby potentially eliminating abrupt reclosure and, perhaps, reducing the incidence of restenosis associated with conventional balloon angioplasty. Photochemical destruction of viable plaque tissue and vasa vasorum with
porphyrins and intraarterial light represents a nonthermal,
laser-based approach that could have a prophylactic role in slowing progression of diffuse atherosclerotic disease. The remarkable versatility of
lasers is responsible for the multiplicity of approaches being investigated and for the current optimism that
lasers will eventually play an important role in the percutaneous treatment of
atherosclerosis.