In this article we will look at:
- What is laser angioplasty?
- Eligibility for laser angioplasty
- How is laser angioplasty performed?
- Inserting a stent after laser angioplasty
- Risks of undergoing the laser angioplasty procedure
- Benefits of undergoing the laser angioplasty procedure
- Alternatives to laser angioplasty
- Pre-procedure guidelines before undergoing laser angioplasty
- Possible complications of laser angioplasty
- Post-operative guidelines after undergoing laser angioplasty
- Recovery from a laser angioplasty procedure
- Are the results of laser angioplasty permanent?
- Is the laser angioplasty a success?
- Cardiology Related Topics
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What is laser angioplasty?
Similar to balloon angioplasty, laser angioplasty is a procedure to open coronary arteries narrowed by plaque. In the laser angioplasty procedure, a laser emitting catheter (a thin flexible tube) is inserted into an artery, then guided to the location of the blockage. Once there, the laser is turned on, and pulsating beams of light are directed towards the plaque. The plaque vaporizes into gaseous particles, layer by layer, thus reducing the block in the artery. This technique is not used as frequently by the doctors as other angioplasty procedures.
The procedure can take anywhere from 30 minutes to 3 hours depending on the patient’s medical condition. The cost of this procedure may range between Rs. 1,00,000 to Rs. 3,60,000 in India.
Generally, mild sedation is used for the procedure, though in some cases general anesthesia may be used.
Overnight hospitalization may be required for a few patients depending on the recovery post the procedure. Hospitalization is generally for 2 days or less for patients undergoing balloon angioplasty.
Am I eligible for laser angioplasty?
Physical symptoms may interfere with the quality of your life due to coronary artery narrowing such as shortness of breath, profound weakness when exerting yourself physically and continuous discomfort in the chest.
You are eligible for laser angioplasty if:
- the narrowing of arteries have led to reduced blood flow, resulting in poor heart function, and chest pain.
- your left coronary artery is narrowed by more than 70%, in which case, you need to opt for angioplasty or a surgery whether or not you are symptomatic.
- reduction of more than 50% in blood flow in the left main coronary artery, or more than 70% to the epicardial (a branch blood vessel, also called epicardial coronary artery, that lies on the surface of the heart) vessel.
Not every narrowing can be treated with angioplasty, especially if you have several blockages or the blockages are located in certain inaccessible locations. It can be performed only if the blockage is severe or the blockage cannot be resolved with medicines.
Also, you need to inform your doctor if you are pregnant.
Please Note: Eligibility criteria for various medical procedures differs from patient to patient and depends on their general health, medical history, and medical conditions. Please consult a doctor to know more about your eligibility or ineligibility for any medical procedure.
How is laser angioplasty performed?
A laser angioplasty procedure involves the following steps:
- You are positioned on an operating table.
- Digital monitors are connected to track your heart rate, blood pressure, and pulse during the procedure.
- An intravenous (IV) line is inserted into a vein in your hand or arm so that medication can be administered to you intravenously. Depending on your medical condition, an appropriate type of anesthesia will be administered.
- Disinfectants are applied on the area of your body (the upper leg or the wrist) where the catheter (a thin flexible tube) is to be inserted. The area is then covered with a surgical drape.
- Once the anesthesia takes effect, the cardiologist begins the angioplasty procedure by making a very small skin incision at the site (upper leg or the wrist).
- If the upper leg is chosen, the cardiologist inserts a thin tube called catheter through the femoral artery. (The femoral artery is the second largest artery in the body and is located in the thigh. The primary function of this artery is to supply blood to the lower section of the body.)
If the wrist is chosen, the cardiologist inserts the catheter through the radial artery. (The radial artery is a major artery in the human forearm. It supplies oxygenated blood from the lungs to the arm and hand.)
- The cardiologist carefully guides the catheter through the arteries into the narrowed area part of the coronary artery.
(As arteries have no nerve endings you will not feel any unpleasant sensation while the catheter is inserted through the artery.)
- Once the catheter reaches the narrowed artery, the cardiologist injects a special dye (also called radiographic contrast agent) through the catheter, which highlights the arteries. The X-ray machine is used to capture the images of the outlined arteries which reveal the location of the narrowing.
- Once the shape and size of the block is ascertained, the cardiologist directs laser beams towards it, thus, burning away the plaque.
Laser-Assisted Balloon Angioplasty
This procedure may be performed immediately after the laser angioplasty procedure explained above, to widen the narrowed artery and improve blood flow, if the cardiologist deems it fit.
In laser-assisted balloon angioplasty, the following additional steps are involved:
10. The cardiologist inserts a wire, with an attached deflated balloon, through the catheter, into the now cleared area.
11. Once the catheter with the balloon is in position, the cardiologist inflates it to widen the artery.
12. X-rays are taken to determine how much the blood flow has improved. When the cardiologist is satisfied with the widened artery, he removes the balloon, the guidewire, and the catheter.
Inserting a Stent After Laser Angioplasty
Depending on your condition, the cardiologist may choose to insert a stent to prevent the artery from blocking or narrowing again after laser angioplasty.
To insert a stent immediately after laser angioplasty:
10. The cardiologist using a guidewire guides the deflated balloon which is enclosed within a stent to the cleared area.
11. Once it is in position, the cardiologist inflates the balloon and then slowly removes it along with the guidewire and the catheter, leaving behind the stent.
What risks will I face while undergoing the laser angioplasty procedure?
The risks of undergoing laser angioplasty include:
- Injury to the artery while inserting the catheter
- Excessive bleeding at the catheter insertion site that may require special medication or a blood transfusion.
- Risk of stroke during the procedure.
- Irregular heartbeat (arrhythmias)
After the procedure, there may also be the risks of infection and blood clotting.
How will I benefit after undergoing a laser angioplasty procedure?
The various benefits of laser angioplasty include:
- Relatively a low risk and less invasive procedure compared to surgical interventions such as bypass surgery.
- This is a minimally invasive procedure in which only a minor cut on the skin is required which does not even require suturing.
- The recovery time is far less than any surgical procedure. An extended stay at the hospital is not required for this procedure.
What are my alternatives to laser angioplasty?
Alternatives to laser angioplasty include:
- Medications and lifestyle changes, if your condition isn't immediately life-threatening.
Your doctor may prescribe medications, such as beta-blockers, nitrates, calcium channel blockers, and lifestyle changes, such as quit smoking, a heart-healthy diet, and exercise. These changes can effectively alleviate your heart condition.
- Coronary stenting
- Balloon Angioplasty
- Coronary Artery Bypass Surgery
What are the pre-procedure guidelines I should follow for laser angioplasty?
The usual pre-procedure guidelines followed are:
- The doctor will ask for your complete medical history prior to the procedure which includes your current medication and any known allergies.
- You may be asked to stop taking certain medication (especially blood thinners) for a specified duration before the procedure.
- A complete physical examination by your doctor to ensure your fitness to undergo the procedure. You may have to undergo blood tests or other diagnostic tests.
- Some tests are performed which include:
- chest x-ray
- electrocardiogram (ECG)
- blood tests
- an imaging test called coronary angiogram
- You'll be advised not to take anything orally (food, liquids or tablets) 6 to 8 hours before the scheduled procedure.
- Woman need to inform the cardiologist and X-ray technologist if she is pregnant or likely to be pregnant. (It is not advisable to take an X-Ray or undergo any radiological testings during pregnancy. Additional care will be provided for pregnant women, so as to not expose the fetus to radiation).
- If you are a smoker or consume alcohol, you will be advised to not to do so, for at least a week or two prior to the procedure. In fact, the doctor will advise you to quit smoking altogether as this is a major cause of atherosclerosis.
What are the complications of laser angioplasty?
Laser angioplasty is generally safe, however, in some cases, complications may occur. Some of the complications are:
- The artery narrowing may recur.
- A relatively rare complication called occlusion or abrupt vessel closure which occurs in the area treated. This narrowing may occur within 24 hours of the procedure. If it happens, medication is administered into the artery to dissolve clots followed by angioplasty or stenting. In certain cases, emergency bypass surgery may be needed.
- Damage to the blood vessel through which the catheter is guided, as well as bruising or bleeding at the puncture site.
- Damage to a heart valve.
- Damage to a blood vessel.
- The contrast dye used during this procedure may cause renal failure, though your cardiologist generally checks your renal function before performing this procedure.
- Heart attack.
- Irregular heartbeat (arrhythmias)
- Stroke (rarely occurs)
Please consult your cardiologist to be aware of all the possible complications that may occur.
What are post-operative guidelines I need to follow after undergoing a laser angioplasty procedure?
Once the procedure is over, you can return home and take post-procedure care which includes:
- taking plenty of rest and drinking plenty of fluids.
- avoid any form of strenuous exercise or lifting heavy objects till your doctor tells you it is safe.
- avoiding sexual activities for up to 5 days.
- quit smoking (permanently).
- promptly reporting to your doctor if you see a change in skin colour in your leg, pain or warmness in the area where the catheter was inserted.
- taking your medicines without fail, especially the medicines given to prevent clotting of blood. Do not stop taking the anti-clotting and antiplatelet medicines without consulting your doctor. They are highly essential to keep strokes and heart attacks at bay.
- changing to a healthy diet post the procedure and inculcating healthy lifestyle changes which include avoiding smoking and drinking.
- limit usage of any staircase for the first 2 to 3 days, and if possible avoid it altogether.
- ensure the area where the catheter was inserted does not get wet for 48 hours after the procedure.
- maintain regular follow-ups as advised by your doctor.
- report to the doctor immediately if you experience pain in the chest or in the leg or wrist, allergic reaction to medications, experiencing dizziness or weakness, fever, and chills.
To take care of the incision site:
- follow the directions of your doctor on how often the dressing needs to be changed.
- if sudden bleeding occurs at the site of the incision, lie down and gently put pressure on your incision site for about 30 minutes. If the bleeding does not stop, return to the hospital or call the medical emergency service.
What is the recovery period after undergoing a laser angioplasty procedure?
In general, patients are able to walk around within a few hours after undergoing the angioplasty procedure, depending on how the procedure went and where the catheter was placed.
Complete recovery takes about 5 - 7 days.
Are the results of laser angioplasty permanent?
Angioplasty can prevent heart attacks or strokes for a long period of time; however, some people do experience recurring narrow arteries again. Then, repeat angioplasty procedures will be required.
If angioplasty is coupled with healthy lifestyle changes, then there is a less likelihood of recurrence.
How do I know if the laser angioplasty procedure I underwent is a success?
The imaging tests taken during post-procedure follow-up visits will clearly show the volume of blood flow in the artery. Normal/adequate blood flow is indicative of a successful outcome of the procedure. Repeat procedures may be necessary if indicated.
More Cardiology Related Topics
People interested in this topic also read:
1. Cook S, Eigler N, Shefer A, Goldenberg T, Forrester J, Litvack F. Percutaneous excimer laser coronary angioplasty of lesions not ideal for balloon angioplasty. 2018. Available at: http://circ.ahajournals.org/content/84/2/632. Accessed February 23, 2018.
2. Grundfest W, Litvack F, Hickey A et al. The current status of angioscopy and laser angioplasty. 2018. Available at: http://www.jvascsurg.org/article/0741-5214(87)90251-5/fulltext. Accessed February 23, 2018.
3. JA B. Clinical results with excimer laser coronary angioplasty. - PubMed - NCBI. Ncbinlmnihgov. 2018. Available at: https://www.ncbi.nlm.nih.gov/pubmed/9552503. Accessed February 23, 2018.
4. Blebea J, Ouriel K, Green R et al. Laser angioplasty in peripheral vascular disease: Symptomatic versus hemodynamic results. 2018. Available at: http://www.jvascsurg.org/article/0741-5214(91)90214-F/fulltext. Accessed February 23, 2018.
Questions answered by trusted doctors
Did you know?
It's possible to experience no symptoms even with multiple blockages
It’s possible to have significant coronary artery disease (CAD) with multiple blockages greater than 70% and yet experience no symptoms of angina on exertion. This is called a silent heart attack. In most of the cases this can happen to people who lead a very sedentary lifestyle.
Angioplasty is not generally recommended for blockages below 70%
Angioplasty is not generally recommended for blockages below 70%. There is no proven benefit in implanting a stent in an area of blockage that does not impair blood flow to the heart muscle. These blockages require only medications and lifestyle changes to be treated successfully.
Heart attacks are triggered by unstable coronary artery blockages of less than 70%
Heart attacks are often triggered by unstable coronary artery blockages that are less than 70%, which does not cause any symptoms. In fact, only 20%-30% of heart attacks occur at the site of an artery that is more than 70% blocked. If you have one blocked artery causing you chest pain and other cardiac symptoms, consider that to be merely the tip of the iceberg.
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