What is laser? Laser is a type of therapeutic interventional cardiac procedure that opens blocked heart arteries. Laser is an acronym for light amplification by stimulated emission of radiation. The laser energy is used to evaporate and remove the blockage. The procedure involves placing a laser catheter in the heart artery and advancing it to the site of the blockage. The laser is turned on, and energy is delivered to the blockage to evaporate it. Then, the laser catheter is removed. Often, angioplasty is performed after this procedure to improve the results.
What are the risks? The risks of laser are low. The risks include all of the complications noted for cardiac catheterization; but some of the risks, specifically heart attack and emergency bypass surgery, are higher because laser is a more complex procedure. The risks include injury or tearing of an artery, which can cause the artery to close. The risk of injury to the artery is somewhat higher with laser than with angioplasty. The injuries are often successfully treated with continued angioplasty. In rare cases, the tear is difficult to treat. Five percent of patients may have a heart attack, and two percent may need emergency bypass surgery. A cardiac surgery team is available at the Inova Heart Center if needed. In three to five percent of patients, the procedure is unsuccessful because the catheter cannot be advanced to the blockage or the artery cannot be fully opened. This can occur when the artery is small, has calcium deposits, or has severe bends. Click here to read more about the Inova Heart Center's outcome indicators regarding angioplasty.
What are the benefits? Laser will open blocked arteries and improve blood flow to your heart. It relieves symptoms, improves exercise duration, and in some cases stops or prevents heart attacks. It may be more effective than medications in relieving symptoms in patients with a blockage in one artery. Following a laser, many patients can stop or reduce their number of heart medications.
How effective is laser? Laser is initially successful in about 90% of patients. However, 30 to 60% of patients will develop a recurrence of the blockage (called restenosis). This occurs because laser injures the artery. The artery's healing process can cause an overgrowth of cells and other substances that cause a recurrence of the blockage. Restenosis usually occurs during the first six months. Your doctor will follow you closely for a return of symptoms and may even perform an exercise stress test. If a blockage returns, you can be treated with medications, a second laser or other interventional procedure, or possibly bypass surgery. Click here to read more about the successful outcomes of angioplasty at the Inova Heart Center.
Is laser right for you? Laser can be used to treat many types of blockages. However, it is not used frequently because it is a technically more complex procedure that has a higher rate of complications than angioplasty and a similar rate of restenosis compared to angioplasty. Unfortunately, the evaporation and removal of the blockage do not lower restenosis rates. Laser is primarily used in treating blockages that are difficult to treat well with angioplasty. Laser is useful in treating blockages that are totally occluded, are very severe and cannot be crossed with an angioplasty catheter, are located in a bypass graft, are a restenosis in a previously placed stent, or are located at an artery origin.
For more specific information regarding before, during and after the procedure, click here.