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235
Fig. 2. This shows how the contact probe screws onto the
connector assembly at the distal end of the optical catheter.
The catheter contains a 600 km optical core fibre which terminates 0.1 mm proximal to the distal end of the screw
threads.
236
Ashley et al.
Rear facet o f sapphire
Fig. 3. Schematic diagram of sapphire contact probe indicating dimensions of probe components shown in Table 1.
Five different types of rounded sapphire contact probe potentially suitable for laser angioplasty were studied (Fig. 1). Three were supplied
by Surgical Laser Technologies (SLT, Malvern,
PA) [outer diameter of probes in parentheseslMTRL (3 mm), MTR (2.2 mm), and SMTR (1.8
mm) using an SLT CL60 CW Nd-YAG laser
(1,064 nm) and SLT optical fibers. Two were supplied by Living Technology (LT, Glasgow, UK)LT (2.2 mm) and Osada [OS] (2.2 mm), using an
LT Flexilase 100 CW Nd-YAG laser (1,064 nm)
and LT optical fibers. The synthetic sapphire
crystal is mounted in a metal holder which screws
onto a metal connector at the termination of the
optical fiber (Fig. 2). The metal holders have either two or one (LT probe) cooling ports situated
just behind the rear facet of the sapphire. The
dimensions of each probe according t o the schematic diagram in Figure 3 are shown in Table 1.
The catheter delivery system in each case
consisted of a 0.6 mm internal quartz optical core
surrounded by an outer Teflon catheter for saline
A. Diameter
B. Length of
protruding
sapphire
C. Total length
of sapphire
D. Length of
metal holder
SMTR
MTR
MTRL
LT
0s
1.8
2.2
3.0
2.2
2.2
1.0
1.5
3.5
1.5
2.5
3.2
3.0
5.0
3.2
6.0
3.5
3.5
3.5
3.5
6.2
237
Heat gun u n i f o r m
heat source
F150-A DGHH power meter prior t o each exposure. Measurements were repeated three times at
each power/duration setting t o obtain a mean
temperature rise above ambient temperature. All
experiments were conducted a t room temperature.
Ashley et al.
exposures of 10 W for 1 second being the usual
TABLE 2. Emissivity (Em) of Sapphires and Proximal
Metal Holders
parameters during clinical arterial recanalisaProbe
S a m h i r e Em
Metal holder Em tion). Figure 6 shows the time course of mean surface temperature rise for the different probes at
SMTR
0.74
0.35
the 20 W power level, the maximum used in this
MTR
0.76
0.35
study. Figure 7 shows the linear relationship beMTRL
0.77
0.35
LT
0.76
0.40
tween mean surface temperature rise of the
0s
0.73
0.16
probes with increasing power using 1 second exposure times (correlation coefficient r = 0.98,0.99,
0.98, 0.96, 0.96, for SMTR, MTR, MTRL, OS, and
ments were made with and without saline perfu- LT sapphires, respectively [ P < O . O O l , all probes]).
sion of the fibers. This method was chosen rather The effect of laser power and exposure on sapthan using an integrating sphere, as it only mea- phire temperature were highly significant using
sures the antegrade optical transmission, as op- 3-way analysis of variance (ANOVA) [P<O.OOl].
posed to the total transmission including laterally At all laser settings the three SLT sapphires
scattered light. These data therefore give an in- reached higher temperatures than the LT and
dication of how much light is either absorbed by sapphires (P<O.OOl), 3-way ANOVA and Sheffes
the probe, scattered outside the probe, or reflected method for comparing contrasts).
back up the optical fiber.
Interface Heating
Scanning Electron Microscopy (SEM) of Sapphire
Figure 8a is a thermal image showing heatProbe Surface
ing of the distal catheter just proximal to the
The front surface of each type of sapphire metal connector, with an Osada sapphire, lasing
probe was examined by scanning electron micros- at 1W for 5 seconds without saline perfusion. It is
copy. New probes were examined before any ex- at this point that excessive back-heating or inadposure to laser energy. Each probe was secured equate cooling may result in melting of the fiber
onto an aluminium stub with adhesive. Electrical and tip detachment (Fig. 8b). Mean distal cathecontact was made with Carbon Dag (suspension of ter and metal holder temperature rise above amcarbon in organic medium). The probes were sput- bient temperatures of all five delivery systems is
ter coated with gold using an Emscope SC 500
shown in Table 4.Distal catheter heating was sigGold Sputter Coater and scanning electron mi- nificantly greater with the LT and 0s probes
croscopy performed with a Cam Scan S.E.M. (Se(P<O.OOl, one-way AVOVA), it being virtually
ries 3 ) .
negligible with the SLT probes, even in the absence of saline perfusion. The maximum metal
holder temperature rise observed with perfusion
RESULTS
at 2 ml/minute was 35C (lasing a t 20 W for 5
Emissivity
seconds).
The emissivity of the sapphires and their
metal holders is shown in Table 2. The outer clad- Optical Transmission Characteristics
ding of all delivery catheters tested had an emisThe optical transmission of the sapphire consivity of 1.
tact probes expressed as a percentage of the light
Temperature of Sapphire Contact Probes
transmitted through the same optical fiber withPanels a and b of Figure 5 show typical ther- out the sapphire mounted is shown in Table 5. No
mal images of the 0s and MTR sapphire probes, difference was made by saline perfusion of the
respectively. Heat is localised within the crystal fibers.
and cross-hairs may be moved across the screen t o
provide a digital indication of the temperature at Scanning Electron Microscopy of
any point on the image. Table 3 shows the peak Sapphire Surface
surface temperature of each sapphire tip in air.
High power magnification views of the front
The results are expressed as the mean tempera- surface of LT, and MTR sapphires are shown in
ture rise above ambient temperature of each sap- panels a and b of Figure 9, respectively. The LT
phire a t 5, 10, and 20 W laser power for exposure sapphires have a smooth, highly polished regular
durations of 1, 2, 3 , 4, and 5 seconds (repeated surface. Although not shown, the
probes sim238
0s
0s
239
0s
Duration (seconds~
2
3
4
*
*
2 7 2 1 3 9 2 1 4 5 2 1 4810
4920
65 f 2 104 f 1 148 2 3 161 z 12 175 ? 8
139 2 8 257 2 6 315 f 4 319 z 2 339 2 2
3 3 t 0 4921 5620 64-1
63 2 2 94 2 3 118 2 1 138 z 0
1 1 7 k 2 209 t 4 278 2 1 316 = 6
SMTR
MTR
MTRL
iz-0 s
LT
7020
149 f 2
327 2 1
0
3 8 2 1 6 1 2 2 8 6 2 3 1 0 8 ~ 21 2 9 2 1
74 2 4 112 2 1 141 2 2 180 I
1 232 2 18
130 2 6 175 2 1 229 2 7 280 2 10 314 2 7
5
10
20
4021
1 1 2 0 2 0 t O 2 7 2 0 3110
2020 3020 4322 5 1 ~ 254f4
3 6 2 4 7 3 2 2 9 0 2 1 9 7 ~ 51 0 8 2 1
5
10
20
LT
*At all laser settings the temperatures of the three SLT sapphires were higher than the 0s and LT sapphires (3-way
ANOVA, p< 0 .OO 1).
ilarly have a smooth polished appearance. In contrast, the surface of the MTR probes which are
identical t o the other SLT probes examined, have
E X W s J r p t l d r a t L I IS, L h e r
2:) W
Ashley et al.
240
,5
10
It
Laser Power ( a )DJratior 1 s
20
creation of a localised region of high power density right at the tip of the probe, which may be
placed precisely against the target tissue without
risk of contaminating the optical fiber. This reduces the total energy required to achieve the desired therapeutic effect, thereby reducing damage
t o neighbouring tissue [lo]. Sapphire contact
probes are available in a variety of geometric
shapes. The rounded probes, developed for vaporisation of tissue, are atraumatic and therefore potentially suitable for laser delivery within arteries. The probe helps to maintain a coaxial position
within the vessel and reduces the risk of lasermediated and mechanically induced perforation
[ll]. The sapphire may be placed in contact with
occlusive plaque providing tactile feedback to the
operator. Ablation is more efficient than with a
bare fiber, and the probe produces a wider lumen
[8]. Early clinical trials using the combination of
contact probes with continuous wave Nd-YAG energy are encouraging and have shown that recanalisation of long occlusions may be effected using repeated 1 second bursts of energy at powers
between 10 and 15 W [12,131.
The suitability of artificial sapphire probes
for laser angioplasty, with respect to their physical properties, has been discussed previously [9].
The interaction of laser energy with the sapphire
may be complex as the transparent crystal will
modify the laser energy in various ways. The
beam profile is focused by refraction at the distal
surface of the sapphire concentrating the photo-
thermal effect at the probe tip. Surface and internal scattering effects may promote energy absorption within the probe resulting in heating of the
sapphire, but this potential effect has not previously been measured directly. Furthermore, backreflection and scattering may give rise to undesirable and possibly dangerous effects such as
heating of the metal holder and fiber just behind
the sapphire. The thermal and optical characteristics of sapphire probes may be influenced by
many factors such as shape, surface geometry,
and the presence of surface coatings, as well as
optical alignment and connection with the optical
fiber. In these respects one might expect variation
242
Ashley et al.
Fig. 9. Scanning electron microscopy views (magnification X 3,000) of the front surface of an
LT sapphire (a) and an SLT sapphire (b). The irregular surface of the SLT probe enhances
absorption of energy and promotes surface heating.
to the sapphire-tissue interface. Furthermore, the rear facet of the 0s sapphire may also explain its
transmission data suggest that this effect is poor forward transmission (54%) and the greatest
achieved without compromising forward light degree of distal fiber heating (observed at only 1
transmission. In contrast, the surface of the LT W laser power). The greater length of the 0s crysand 0s sapphires is extremely smooth, and sur- tal and metal holder relative t o the other probes,
face heating is, therefore, less pronounced. In the probably explains these latter effects. Although
0s probe maximal heating was in fact noted t o some light may be scattered laterally by this
arise within the posterior region of the exposed probe, being diffuse and poorly absorbed by tissue
sapphire. Excessive reflection of light from the at this wavelength, it is unlikely t o produce any
244
10.
11.
12.
13.
Ashley et al.
of sapphire fibertips for laser angioplasty. Lasers Med Sci
1987; 21183-188.
Daikuzono N: Contact delivery systems and accessories.
In: Joffe SN, Oguro Y, (eds): Advances in Nd-YAG Laser
Surgery, New York: Springer-Verlag, 1988, pp 19-29.
Bowker TJ, Cross FW, Bown SG, et al.: Reduction of vessel wall perforation by the use of sapphire tipped optical
fibers in laser angioplasty. Br Heart J 1987; 57:88.
Pilger E, Lammer J, Kleinert R, et al.: Laser angioplasty
with a contact probe for the treatment of peripheral vascular disease. Cardiovas Res 1988; 22:149-153.
Lammer J, Karnel F: Percutaneous transluminal laser
angioplasty with contact probes. Radiology 1988; 168:
133-737.