In the coronary arteries, cardiologists sometimes encounter stubborn calcified plaques that are highly resistant to traditional cardiac procedures for plaque removal like balloon angioplasty and stenting. In such cases, the effective option is to remove these plaques using a laser beam in a process called laser angioplasty or excimer laser angioplasty.
Simply put, a laser beam is shot at the calcified plaque inside the artery with extreme precision. This vaporizes the plaque and clears the artery to insert a stent to widen the narrowed arterial walls and ensure proper blood circulation. If not attended to in time, narrowed coronary arteries can lead to conditions ranging from chest pain to irregular heart rate and even heart attack due to clot formation in some cases.
What is laser angioplasty?
Dr Srinivas Prasad, senior consultant, interventional cardiologist and heart valve replacement specialist, Fortis Hospital, Bannerghatta Road, Bangalore, says laser angioplasty is recommended in cases with extremely thick plaques which have to be cleared before balloon angioplasty and stenting can be carried out to clear the blocked artery.
Balloon angioplasty is the most common procedure for opening blocked arteries using a catheter with a balloon. The catheter is inserted inside the narrowed artery from the groin or wrist and is inflated at the narrowed plaque-laden portion to widen it and allow improved blood circulation. A stent is also placed to support the arterial walls, keep them open and reduce the chances of narrowing again.
“These blockages are caused due to cholesterol deposits in the arterial wall. It leads to the narrowing of the artery lumen obstructing blood flow. Calcification of plaques due to excess calcium deposition
Excess calcium deposits can cause calcification on these plaques as well, which makes them thick and hard to remove, Dr Prasad shares.
How does laser angioplasty work
Laser angioplasty involves using a catheter equipped with laser fiber that emits a concentrated high-energy laser beam (excimer laser) to smoothen or remove fatty deposits in blocked arteries.
To begin with, the doctor inserts the catheter into a small incision, typically in the wrist or groin, to clear plaque. The catheter is inserted till the tip is in direct contact with the lesion (coronary plaque), where the laser emits highly concentrated beams of energy. This laser energy can vaporize the plaque, informs Dr Pradeep Haranahalli, consultant – interventional cardiology, Manipal Hospital, Whitefield, Bengaluru.
Dr Haranahalli explains that fluoroscopy (real-time X-ray) is used to navigate the catheter to the precise location of blockage. “After the catheter is inserted, we use laser energy focally to soften the calcium and clear it,” Dr Haranahalli adds.
Once the plaque is removed, the artery slowly expands, and the arterial lumen (a hollow passageway through which blood flows) widens and normal blood flow is restored.
“After the blockage is removed, we reassess the situation to check if a stent procedure is necessary,” he adds.
Benefits of excimer laser angioplasty
Traditional methods like rotablation angioplasty use a rotablator drill to break the heavily calcified plaques into small pieces. But, in laser angioplasty, the beam vaporizes the cholesterol-laden plaque and clears the artery for blood flow.
Dr Prasad also points out that Shockwave intravascular lithotripsy (IVL lithotripsy) and orbital atherectomy are other traditional methods used to clear hardened calcified plaques.
Is laser angioplasty safe?
Dr Prasad shares that laser angioplasty is beneficial as it is more precise — it helps ensure the breakdown of hard calcified deposits without affecting the surrounding tissue. Moreover, the high-accuracy laser emission is highly regulated to prevent complication
According to Dr Prasad, normally, laser angioplasty is considered safe. “However, when we try to remove calcification, there’s a chance of a minor injury to the vessels, which slows down blood flow. Such issues are rare with laser angioplasty as compared to any other technology,” he adds.
When to consider laser angioplasty
Dr Prasad says laser angioplasty is used when calcification is a major concern. However, for a simple lesion or cholesterol blockage, it is not required. Dr Haranahalli informs that laser angioplasty is not always the first choice for every case of arterial blockage. It is mostly used in complex blockages, where traditional angioplasty methods such as balloon angioplasty do not work.
He adds that the success rate of laser angioplasty is around 90 percent with very rare complications. Laser angioplasty might cost 2 to 3 lakhs more than traditional methods.
Excimer laser angioplasty or laser angioplasty is a medical treatment used to remove blockages or narrowing of the arteries to reduce the risk of heart problems such as heart attacks. It can be effective in cases of complex blockages (thickened or hardened plaque), where traditional angioplasty methods may not fully address the underlying issue.