Laser-induced dissections: Pathogenesis and implications for therapy

TY - JOUR

T1 - Laser-induced dissections

T2 - Pathogenesis and implications for therapy

AU - Isner, Jeffrey M.

AU - Pickering, J. Geoffrey

AU - Mosseri, Morris

N1 - Funding Information: JEFFREY M . ISNER, MD, J . GEOFFREY P ICKERING . M D . PHD . MORRIS MOSSERI, MD Boston, Sfarscrl .''t Tn , lathe short span of one decade . cardiovascular applications of laser technology have progressed from a laboratory curiosity to a device for coronary revascularization approved by the Food and Drug Administration . It is no coincidence that this same decade witnessed the full maturation of pulsed laser technology . Development of laser technology . Initial biomedical applications of laser technology relied nearly exclusively on continuous wave lasers. The output power achieved by these lasers was typically well under 100 W . The continuous fashion in which continuous wave laser irradiation was administered consistently overwhelmed the ability of boundary tissues to dissipate heat responsible for target tissue ablation . Even frequent interruption of the laser output (so-called chopped mode) proved inadequate to prevent thermal injury (1) . as compensatory mechanisms designed to achieve a similar magnitude of tissue ablation were limited to simply increasing cumulative exposure time. Although the ultimate sequetae associated with thermally injured tissue continue to be debated, there is no debate regarding the extent to which medium-sized arteries failed to tolerate the potent vasoconstrictor effects of heat generated by these lasers (2) . The latter ultimately made continuous wave lasers unsuitable for use in coronary arteries . The twin insults of thermal injury and vasospasm were successfully addressed by the advent of the pulsed laser. The design of this second-generation laser permitted sufficient storage of energy before each discharge so that instead of watts, these lasers delivered peak powers in the megawatt or kilowatt range . Accordingly, exposure time could be re- reflect the views of the authors and do not necessarily represent the views nr JACC or the American College ofCardiology, From the Depxnmenu of Medicine (Cardiology) and Btomediut Re-ares, St. Elisabeth's Hospital, Tutu lniversily School of Medicine . Boston, Mas .mchuseus. This stedy gas supported in part by Grant HL 40518 Soma the National Hear . Lung . and Oleed Inslimm . Satiated Institutes of Health. Bethesda . Maryland (Dr. (snarl : the Medical Research Council of Canada ID, Pickering) and the American physician's Fellowship (Dr . Stos- serilAddress. for re r nts : Jeffrey M. Inner . Mo. SL

PY - 1992/6

Y1 - 1992/6

UR - http://www.scopus.com/inward/record.url?scp=0026690399&partnerID=8YFLogxK

U2 - 10.1016/0735-1097(92)90628-Z

DO - 10.1016/0735-1097(92)90628-Z

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C2 - 1593059

AN - SCOPUS:0026690399

SN - 0735-1097

VL - 19

SP - 1619

EP - 1621

JO - Journal of the American College of Cardiology

JF - Journal of the American College of Cardiology

IS - 7

ER -