Translational research

DOI: 10.4244/EIJ-D-23-00487

Intravascular laser lithotripsy for calcium fracture in human coronary arteries

Aleksandra B. Gruslova1, PhD; Nitesh Katta2, PhD; Drew Nolen1, MS; Scott Jenney2, BS; Deborah Vela3, MD; Maximilian Buja3, MD; Mehmet Cilingiroglu1, MD; Yasamin Seddighi4, MS; Hai Chao Han4, PhD; Thomas E. Milner2, PhD; Marc D. Feldman1, MD

Abstract

Background: Electrical intravascular lithotripsy (E-IVL) uses shock waves to fracture calcified plaque.

Aims: 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.

Methods: 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.

Results: 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...

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Volume 19 Number 11
Dec 18, 2023
Volume 19 Number 11
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