Laser angioplasty: Not the magic wand many heart patients imagine it to be

One often hears patients walking into urban hospitals, insisting on a ‘laser angioplasty’. It conjures images of a laser beam magically zapping away blockages, much like a skin laser treatment done in beauty clinics.It’s anything but that, say cardiologists. “People think a laser procedure means there will be no stent and no invasion, just a quick zap like a cosmetic laser. But that is not the case at all,” says Pune-based senior cardiologist Dr Suhas Hardas. An Excimer Laser Coronary Atherectomy (ELCA), commonly known as laser angioplasty, requires the same catheter-based route through the groin or wrist as a regular balloon angioplasty. The difference lies only in the tool: a specialised catheter that delivers ultraviolet pulses to vaporise soft clots and calcium deposits inside arteries. A wire still needs to be passed inside the artery, a balloon follows, and a stent may still be required. “The laser is only one part of the process,” adds Dr Hardas.The very idea of a laser dissolving a clot has a futuristic appeal, with hospitals in metropolitan cities reporting a marked rise in demand for the technology. But experts stress that while a laser is powerful, its use is best reserved for highly specific situations. “For example, if a patient in his 20s or 30s suffers a heart attack because of large clots but without major cholesterol deposits, the laser can effectively vaporise those clots and restore blood flow. It’s one of the best uses of this technology,” says Dr Deepak Davidson, chief cardiologist at Caritas Hospital and Heart Institute in Kottayam, Kerala. Patients who have undergone angioplasty and develop a new blockage later also benefit from the laser procedure. Though rare, the laser can also help clear in-stent blockages years after the initial procedure. In significant calcification where the balloon fails to negotiate the blockage, lasers can make a difference. However, ELCA is not meant for very severe and calcified plaques. In such cases, atherectomy devices that drill through rock-hard calcium remain the tools of choice. Also, total blockages where even a wire fails to cross remain unsuitable for laser use.It’s also expensive and not a substitute for conventional angioplasty. “It’s one more tool in our box. It works beautifully in the right case, but is not needed for most patients,” Dr Hardas points out.A laser procedure may appeal more to heart patients but it is skill and judgement, not just the shine of technology, that saves lives.