Clinical aspects of laser ablation of atherosclerotic plaques: prospects for 213 nm ultraviolet endarterectomy

Background . Laser atherectomy is used for selected complex atherosclerotic lesions, but direct clinical evidence for intravascular 213 nm laser treatment is currently lacking. The technology is of interest because of the physicochemical properties of deep-ultraviolet radiation and advances in hollow anti-resonant fiber delivery. Objective . To assess the potential clinical relevance of 213 nm laser ablation for atherosclerotic lesions based on available evidence on laser–tissue interaction, current atherectomy techniques, and deep-ultraviolet light-delivery technologies. Materials and methods . A narrative analysis of 15 peer-reviewed sources identified in PubMed/PMC and technical literature was performed. The evidence included clinical guidance and atherectomy studies, experimental work on laser ablation, studies of 213 nm irradiation, and publications on hollow anti-resonant fibers. No direct clinical studies of 213 nm laser treatment in cardiovascular surgery were identified in the reviewed evidence. Results . The 213 nm wavelength has high photon energy and strong absorption in protein-containing tissues. Corneal studies support its potential for precise ablation, but transfer of these findings to atherosclerotic plaque requires dedicated experimental validation. Hollow anti-resonant fibers may address degradation of conventional silica fibers during deep-ultraviolet transmission. Photomechanical approaches using contrast media may be relevant to calcified lesions, but their efficacy and safety at 213 nm remain unestablished. Conclusions . The 213 nm laser has translational potential but remains an experimental technology. Before clinical use, ex vivo and in vivo studies should establish ablation thresholds, delivery characteristics, endothelial and vascular-wall safety, and embolic risk, followed by appropriately designed early clinical studies.