Excimer Laser

Technology

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Agenda
Laser Physics
Mechanism of Photoablation
Application of Photoablation with
Laser Catheters
Laser Safety

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What Is Light?

(mJ)

Amplitude

Light = photon = energy

Photon has a dual nature as both wave & particle
Wave behaviors
Travels in a measureable height and length
Particle behaviors
Has measurable mass
Length

(meters)

308 nanometers

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Laser Basics
Light can be
Reflected- bounces off
Scattered- random dispersal
Transmitted- passes through a
medium unchanged
Refracted- change in direction
Absorbed- deposited in a tissue

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Laser Basics
Lasers= Monochromatic
Single wavelength

Photons travel in phase together

Forms collimated light
Stays focused over distance
Parallel paths

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LASER
Light
Amplification
by
Stimulated
Emission
of
Radiation
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Laser Basics

Light

Stimulated emission

Amplification

How Atoms Work, Retrieved 2/15/20, from http://science.howstuffworks.com/atom2.htm

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Laser

Requirements
Laser Medium
Excitation
Optics- High Reflector Mirror (HR)
- Output Coupler Mirror (OC)
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Excimer Laser Excitation

Laser medium

High voltage added

Hydrogen
Chloride
Xe

Xenon
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CL

A Photon is Born
Dimer

Excimer = Excited Dimer

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Lasers and the Light Spectrum

Ultraviolet

vs.

Infrared

248 nm KrFl
351 nm XeFl

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UV Lasers
UV Lasers (10 to 400 nanometer) are
unique because they
Carry photon energies high enough to break
molecular bonds (covalent)
Avidly absorb in biological tissue
Have shallow absorption depth, <100 microns
Reduces energy required to cut
Reduces collateral tissue effects
Are typically pulsed Lasers
Pulse width of 5 to 200ns
SPNCs ~120ns

2010 Spectranetics

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Why 308nm Excimer Laser?

308nm allows coupling into fiber optics
and delivery to the end of the catheter
135ns pulse duration allows for fiber
optic delivery

2010 Spectranetics

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The Science of
Spectranetics Excimer
Laser Ablation

2010 Spectranetics

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Mechanisms of Action
for Ablation

Photoablation is the use of light to breakdown, vaporize

and remove matter
Spectranetics CVX-300 Excimer Laser facilitates
photoablation via a variety of Spectranetics catheters to
remove arterial plaques and binding scar tissue
surrounding cardiac pacemaker ICD leads
Three distinct mechanisms of action contribute to Excimer
Laser photoablation
1. Photochemical
2. Photothermal
3. Photomechanical

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Mechanisms of Action
X

Photochemical

Photothermal

Photomechanical

Breaking
molecular bonds

Producing
thermal energy

Creating
kinetic energy

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1: Photochemical Mechanism
Breaking molecular bonds

0 - 135 billionths of a second

UV light pulse hits tissue for 135 billionths of a second (135ns);

the duration of the laser pulse
50 microns penetration
Billions of molecular bonds fractured per pulse
After 135 billionths of a second, laser energy is not emitted
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2: Photothermal Mechanism
Producing thermal energy

100 millionths of a second

Absorption vibrates the molecular bonds of the plaque

Vibration of bonds heats intracellular water
Water vaporizes, molecules break apart, therefore rupturing cells
Expanding vapor bubble forms in 100 millionths of a second (100 s)
1000 times the duration of the actual laser energy emission

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3: Photomechanical Mechanism
Creating kinetic energy

400 millionths of a second

Expansion and collapse of vapor bubble breaks down tissue

and clears by-products away from tip
By-products of ablation are water, gas, and small particles
Entire process time per pulse is 400 millionths
of a second (400 s)
4000 times the duration of the actual laser energy
emission
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125 billionths
of a second

100 millionths
of a second

400 millionths
of a second

Timeline of a Single Laser Pulse

Bonds
dissolve

Thermal
energy

Kinetic
energy

Photoablation

Rest Period

Rest Period

25 Hz

1.3%

98.7%

80 Hz

4.0%

96.0%

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Photomechanical Effect
Fast expanding vapor bubble from a single Excimer Laser pulse

45 Fluence

60 Fluence

2.0 mm Vitesse OS catheter in absorbing Liquid

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Photomechanical Tissue Removal

Point 9 in Gel Model

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Application of Photoablation
with Spectranetics Laser
Catheters

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Many Morphologies, One Technology

Photoablation with the excimer laser
ablation system vaporizes
Coronary

Peripheral

Lesion Morphology

TE/TT/TB

Multiple morphology lesions which may

be comprised of atheroma, fibrosis,
calcium and thrombus

ELCA

Lipid-based plaque

ELCA

Occluded saphenous vein graft disease

ELCA

Fibrotic plaque

ELCA

Moderately calcified lesions

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Laser Atherectomy Ablation

Technique
SIZE: Laser catheter diameter should not
exceed 2/3 of the reference vessel
diameter
SALINE: Essential to remove contrast
from the photoablation location
SLOW: Advance SLOWLY at a rate of
<1mm per second for cleaner and larger
lumens
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SIZE of Laser Catheter

Catheter to vessel size ratio should not
exceed 2:3
Catheter Size

Approximate Vessel Diameter

0.9mm

> 1.4mm

1.4mm

> 2.1mm

1.7mm

> 2.6mm

2.0mm

> 3.0mm

2.3mm

> 3.5mm

2.5mm

> 3.8mm

In situations where a conservative approach is desired,

size laser catheter to approximately vessel size.
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Maximum Settings
Peripheral
Product Description and Size
Peripheral OTW/RX

Maximum
Settings

Maximum
Timings

0.9 X 80

80/80

Continuous Pulsed On

Peripheral Turbo Elite

1.4, 1.7, 2.0, 2.3mm

60/80

Continuous Pulsed On

Peripheral Turbo Elite 2.5mm

45/80

Continuous Pulsed On

Peripheral Turbo-Tandem

60/80

Continuous Pulsed On

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Maximum Settings
Coronary
Product Description and Size
Coronary RX

Maximum
Settings

Maximum
Timings

Coronary ELCA Vitesse

0.9mm

60/40

5 sec On (pulsed)
10 sec Off

Coronary ELCA Vitesse 0.9mm X80

80/80

10 sec On (pulsed)
5 sec Off

Coronary ELCA Vitesse 1.4,1.7,2.0

Coronary ELCA Vitesse Eccentric
1.7E,2.0E

60/40

5 sec On (pulsed)
10 sec Off

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Peripheral OTW Saline Infusion

Always perform 10-20cc bolus saline
infusion via the crossover sheath or
guide catheter after contrast injections

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Slow Advancement
Advance the catheter at <1mm per
second for optimal results.
6 cm lesion = 60 seconds =
minimum of 1 minute to cross

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Slow Advancement is KEY!

FAST

Simulated lesion

SLOW

Simulated lesion

Lumen diameter with

FAST ADVANCEMENT
(greater than 1 mm per
second).

Lumen diameter with

SLOW ADVANCEMENT
(less than 1 mm per
second.)

2.3 TURBO in 6mm tube

2.3 TURBO in 6mm tube

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Slow Advancement Is KEY!

SLOW
6mm lumen

6mm lumen diameter with

SLOW ADVANCEMENT
(less than 1 mm per second)

FAST
3mm lumen

3mm lumen diameter with

FAST ADVANCEMENT
(greater than 1 mm per second)

2.5 Turbo-Booster in 20mm lesion model, longitudinal view

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Fast Catheter Advancement

(What to avoid!)

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Key Point - Slow

Excimer Laser removes plaque slowly
For best results- catheter must be
advanced slowly
Slow advancement <1mm/s results in
Larger lumens
Cleaner lumens
Reduced occurrence of dissections

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Calcium Ablation with the

Excimer Laser

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Engineering Observations
With high density catheter and higher fluences, penetration
is slow in moderate calcium. Resulting hole size is very
close to catheter tip diameter.

Point 9 at 80/80 completely penetrates 1mm of calcium after 33

seconds of lasing. In comparison, the Point 9 will penetrate
same thickness of porcine aorta and bovine tendon in 1.2 and
1.7 seconds, respectively.*
* Data on file at Spectranetics
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Calcium Ablation Key Points

308nm excimer laser ablates calcified plaque*
The fluence threshold for moderately calcified lesions
is much higher than other lesion morphologies use
fluences of 60 mJ/mm2 and higher (if available)
For moderately calcified lesions it is recommended to
start with the highest Fluence / Rep Rate
combination
Penetration is very slow in moderately calcified
tissues, therefore patience is often required

* Data on file at Spectranetics

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Calcium Ablation Key Points

High fluence catheters like the Pt9 X80
(coronary) and the Turbo Elite OTW
(peripheral) lines are the best choices for
calcified plaque
Ablated lumen size in hard calcium is
approximately the same size as the tip
This can lead to shaft binding in longer lengths
of hard calcified lesions
Downsizing the catheter may be a good
strategy in this situation
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Laser Safety
Operators trained per IFU
Secure environment
Laser signs posted on all entrances
Laser signs must state the laser classification,
wavelength and that eye protection is required
The CVX-300 is a Class IV Laser System
The CVX-300 is a Class 3 Medical Device (FDA)
The wavelength of the laser light is 308 nanometers
(nm) which is invisible to the human eye

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Laser Safety
Eye protection
Everyone in the room must wear eye
protection, including the patient
Must be labeled with optical density (O.D.)
at laser wavelength
O.D.= 9 @ 308 nanometers (CVX-300 safety
glasses)

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Laser Safety
Common safety sense:
Never directly view laser beam, even with
proper eye protection
Handle the catheter with care - never point
the catheter at anyone

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