End-to-side anastomosis without occlusion of the recipient artery utilizing the excimer laser

A new technique has been developed which enables the creation of an end-to-side anastomosis between arteries with no or an extremely short occlusion time ( 2 min) of the recipient artery for ischemic sensitive areas. The feasibility of the technique was studied in a rabbit model. The right common carotid artery was connected with the exterior of the left common carotid artery. Through an artificial sidebranch, which was connected with the donor artery proximally from the anastomosis, a laser catheter was introduced in contact with the recipient arterial wall. The laser was activated to create a hole in this wall and the artificial sidebranch was subsequently occluded. Meanwhile no occlusion of the donor artery was necessary. In a series of 100 rabbits using a coated hemispherical contact probe (1.8 or 2.2 mm diameter) coupled to a Nd:YAG laser (one 0.5 s, 18 W pulse) a 95 % patency rate was obtained. In a recent series of 20 rabbits an Excimer-laser (Technolas, XeCl 308 nm, 120 ns, 20 Hz, 25 mj/pulse) was used. The hole was created with a custom designed multifibercatheter of 2.2 mm diameter consisting 140 laserfibers in a flat circular configuration. A patency rate of 100% was obtained. Scanning Electron Microscopy of the anastomosis site up till 8 weeks showed a perfect endothelialization. The advantage of the Excimer based multifiber catheter compared with the Nd:YAG based contact probe, is the absence of thermal effects at the site of the anastomosis. A pilot study is in progress in a series of patients, where an extra-intracranial bypass is indicated.