Intravascular laser lithotripsy for calcium fracture in human coronary arteries

医学 冠状动脉 离体 碎石术 管腔(解剖学) 光学相干层析成像 生物医学工程 核医学 放射科 体内 动脉 外科 生物 生物技术
作者
Aleksandra Gruslova,Nitesh Katta,Drew Nolen,Scott Jenney,Deborah Vela,L. Maximilian Buja,Mehmet Çilingiroğlu,Yasamin Seddighi,Hai‐Chao Han,Thomas E. Milner,Marc D. Feldman
出处
期刊:Eurointervention [European Association of Percutaneous Cardiovascular Interventions]
卷期号:19 (11): e913-e922 被引量:1
标识
DOI:10.4244/eij-d-23-00487
摘要

Electrical intravascular lithotripsy (E-IVL) uses shock waves to fracture calcified plaque.We aimed to demonstrate the ability of laser IVL (L-IVL) to fracture calcified plaques in ex vivo human coronary arteries and to identify and evaluate the mechanisms for increased vessel compliance.Shock waves were generated by a Ho:YAG (Holmium: yttrium-aluminium-garnet) laser (2 J, 5 Hz) and recorded by a high-speed camera and pressure sensor. Tests were conducted on phantoms and 19 fresh human coronary arteries. Before and after L-IVL, arterial compliance and optical coherence tomography (OCT) pullbacks were recorded, followed by histology. Additionally, microcomputed tomography (micro-CT) and scanning electron microscopy (SEM) were performed. Finite element models (FEM) were utilised to examine the mechanism of L-IVL.Phantom cracks were obtained using 230 μm and 400 μm fibres with shock-wave pressures of 84±5.0 atm and 62±0.4 atm, respectively. Post-lithotripsy, calcium plaque modifications, including fractures and debonding, were identified by OCT in 78% of the ex vivo calcified arteries (n=19). Histological analysis revealed calcium microfractures (38.7±10.4 μm width) in 57% of the arteries which were not visible by OCT. Calcium microfractures were verified by micro-CT and SEM. The lumen area increased from 2.9±0.4 to 4.3±0.8 mm2 (p<0.01). Arterial compliance increased by 2.3±0.6 atm/ml (p<0.05). FEM simulations suggest that debonding and intimal tears are additional mechanisms for increased arterial compliance.L-IVL has the capability to increase calcified coronary artery compliance by multiple mechanisms.
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