MECHANISM ON THROMBOSIS AND RESTENOSIS AFTER LASER ANGIOPLASTY

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Thrombogenicity and proliferative effects of laser angioplasty was compared with balloon angioplasty in 8 dogs. Mean percent area stenosis by thrombus was 62 (]SY.+-[) 28 in balloon dilated, 31 (]SY.+-[) 29 in laser thermall treated and balloon dilated, 5 (]SY.+-[) 6 in laser thermal-treated, and 1 (]SY.+-[) 2 in directly lased segments at 60 minutes (P<0.0005 vs balloon). In 8 atherosclerotic rabbit iliac arteries, mean luminal diameter increased from 0.19 to 1.54 mm by laser thermal and from 0.29 to 1.84 mm by balloon (P<0.0001, repectively). However, due to thrombotic reobstruction, it decreased to 1.34 for laser and 0.45 for balloon (P<0.0001 vs immediately post) at 60 minutes later. Thus laser thermal angioplasty results less thrombogenecity than balloon angioplasty.We investigated preventive effect of laser angioplasty on restenosis in hypercholesteremic rabbits. One side of atherosclerotic iliac stenosis was dilated by balloon and the other by laser angioplasy. Following angiopl … More asty, luminal stenosis increased from 16 to 58% in balloon-dilated arteries (P<0.05), whereas, it changed from 26% to 30% in laser thermal group and from 28 to 39% in direct laser group. The results suggested that laser angioplasty may prevent restenosis after angioplasty.Thrombogenicity of pulsed laser treated arteries were evaluated in rabbits. Angioscopic mean percent obstruction with thrombus was 8.6 % with laser thermal treatment, and 41.9 % with control balloon (n=7, P<0.0001) at 1 hour after the treatment. It was 3.8 % with excimer and 51.9 % for the control balloon group (n=8, P<0.001). Angioscopic percent luminal obstruction was 1.4 with excimer, 2.6 with holmium YAG,2.5 with Nd-YAG and 49 for balloon angioplasty group (P<0.0001). The results suggested that pulse laster treatment can also reduce thrombogenicity.One side of iliac stenosis was dilated by balloon and the other artery was dilated by laser angioplasty in 18 dogs. Before angioplasty, antithrombin or heparin was infused in 10 dogs. One hour after angioplasty, mean thrombotic stenosis was 62% in balloon control, and 5% in laser thermal group. It was 8.6% in balloon with heparin, 1.2% in laser with heparin, and 0% in laser with antithrombin. The results suggested that adjunctive antithrombotic therapy to laser treatment can completely prevent thrombosis.We investigated laser thermal angioplasty in 27 patients with arteriosclerosis obliterans, and succeeded in 21 patients. With antithrombin therapy, one year patency was 82%, compare with 50% with heparin (P<0.05). Thus laser angioplasty with adjunctive antithrombin is very useful for prevention of acute reocclusion and restenosis. Less