WO2001074265A1 - Traitement de troubles vasculaires au laser a deux longueurs d'ondes - Google Patents

Traitement de troubles vasculaires au laser a deux longueurs d'ondes Download PDF

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Publication number
WO2001074265A1
WO2001074265A1 PCT/US2001/006061 US0106061W WO0174265A1 WO 2001074265 A1 WO2001074265 A1 WO 2001074265A1 US 0106061 W US0106061 W US 0106061W WO 0174265 A1 WO0174265 A1 WO 0174265A1
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WIPO (PCT)
Prior art keywords
wavelength
blood vessel
blood
pulse
pulses
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PCT/US2001/006061
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English (en)
Inventor
George Frangineas
Herbert Pummer
John F. Black
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Coherent, Inc.
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Publication of WO2001074265A1 publication Critical patent/WO2001074265A1/fr

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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/18—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves
    • A61B18/20—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves using laser
    • A61B18/203—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves using laser applying laser energy to the outside of the body
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/00017—Electrical control of surgical instruments
    • A61B2017/00137—Details of operation mode
    • A61B2017/00154—Details of operation mode pulsed
    • A61B2017/00172—Pulse trains, bursts, intermittent continuous operation
    • A61B2017/00176—Two pulses, e.g. second pulse having an effect different from the first one
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00005—Cooling or heating of the probe or tissue immediately surrounding the probe
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00315—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for treatment of particular body parts
    • A61B2018/00452—Skin
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00315—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for treatment of particular body parts
    • A61B2018/00452—Skin
    • A61B2018/00458—Deeper parts of the skin, e.g. treatment of vascular disorders or port wine stains
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/18—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves
    • A61B18/20—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves using laser
    • A61B2018/2065—Multiwave; Wavelength mixing, e.g. using four or more wavelengths
    • A61B2018/207—Multiwave; Wavelength mixing, e.g. using four or more wavelengths mixing two wavelengths

Definitions

  • the present invention relates in general to laser treatment methods for vascular disorders. It relates in particular to the laser treatment of abnormal leg veins or telangiectasia.
  • leg veins can be eradicated only if the selected damage process reaches most of the circumference of the vein.
  • One possible explanation for this may be because abnormal leg veins often have elevated hydrostatic pressure, which may counteract the effects of any less-than-complete vascular damage by restoring blood circulation.
  • the present invention is directed to a method and apparatus for treating vascular disorders with electromagnetic radiation.
  • the method of the present invention comprises delivering to a blood vessel a first fluence of electromagnetic radiation having a first wavelength and a second fluence of electromagnetic radiation having a second wavelength.
  • the second wavelength is longer than the first wavelength.
  • the fluences are delivered in a manner such that they cooperatively cause permanent damage to the blood vessel.
  • delivery of the first fluence to the blood vessel causes one or more of shrinkage of the blood vessel, heating of blood in the blood vessel to a temperature above normal blood temperature, and partial blockage of the blood vessel by partially coagulating blood therein.
  • the second fluence causes complete coagulation of blood in the blood vessel. This contributes to causing the permanent damage.
  • the first fluence alone is not sufficient to cause complete coagulation of blood in the blood vessel, and completion of coagulation can be completed by a second fluence less than that which would be necessary to complete coagulation of blood in the blood vessel in the absence of the first fluence.
  • the first electromagnetic radiation fluence is provided by a first pulse of laser radiation having a wavelength between about 480 nm and 600 nm and the second fluence is provided by a second pulse of laser radiation having a wavelength between about 605 nm and 1350 nm.
  • the pulses are preferably delivered sequentially, with the second pulse being delivered within a time interval less than twice the thermal relaxation time of the blood vessel.
  • Experimental irradiations of vessels of laboratory animals were performed, wherein the first pulse had a wavelength of 532 nm and the second pulse had a wavelength of about 1064 nm. There was a time delay of about 1.0 ms between the end of the first pulse and the beginning of the second pulse.
  • Apparatus for carrying out the method of the present invention includes a first light-source for delivering electromagnetic radiation having the first wavelength and a second light-source for delivering electromagnetic radiation having the second wavelength.
  • a control arrangement is provided for controlling parameters of the electromagnetic radiation delivered by each of the first and second light- sources.
  • the control arrangement includes a sequencer for timing cooperative activation of the first and second light-sources.
  • An optical arrangement is provided for delivering the electromagnetic radiation from each of the first and second sources to the blood vessel.
  • the first and second light sources are preferably solid-state lasers.
  • the first light-source is a pulsed, frequency-doubled Nd. ⁇ AG laser delivering pulses having a wavelength of about 532 nm.
  • the second light- source is a pulsed Nd:YAG laser delivering pulses having a wavelength of about 1064 nm.
  • the optical delivery arrangement includes optical-fiber delivery.
  • FIG. 1 is a graph schematically illustrating diffusion of heat as a function of time from a blood vessel heated by NIR laser radiation.
  • FIG. 2 is a graph schematically illustrating diffusion of heat as a function of time from a blood vessel heated by yellow-green laser radiation.
  • FIG. 3 is a transverse cross-section view schematically illustrating blood coagulation in a large blood vessel irradiated by yellow-green radiation.
  • FIG. 4 is a longitudinal cross-section view schematically illustrating blood coagulation in a large blood vessel irradiated by yellow-green radiation and stenosis of the blood vessel in reaction to the coagulation.
  • FIGS 5A-C are graphs schematically illustrating a preferred delivery sequence of yellow-green and NIR radiation pulses in accordance with the method of the present invention.
  • FIG. 6 schematically illustrates one preferred apparatus for simultaneously or sequentially delivering yellow-green and NIR laser pulses in accordance with method of the present invention, with pulses being delivered along separate paths to a targeted blood vessel.
  • FIG. 7 schematically illustrates another preferred apparatus for simultaneously or sequentially delivering yellow green and NIR laser pulses in accordance with the present invention with pulses being delivered along separate paths to a targeted blood vessel.
  • FIG. 8 schematically illustrates yet another preferred apparatus for simultaneously of sequentially delivering yellow green and NIR laser pulses in accordance with the present invention with pulses being delivered along a common optical-fiber to a targeted blood vessel.
  • FIG. 9 is a graph schematically illustrating results of experimental, two-pulse irradiations in accordance with the method of the present invention on blood vessels of laboratory animals.
  • FIGS 10A-C are graphs schematically representing alternate delivery sequences of yellow-green and NIR pulses in accordance with the present invention.
  • FIG. 1 graphically, schematically illustrates calculated heat distribution as a function of time in a blood vessel heated by a pulse of NIR radiation.
  • the vertical (Y) axis is assumed to be the center of the vessel and vertical line A is assumed to be the vessel wall.
  • Vertical line B situated 100 ⁇ m from the vessel wall is assumed to be the position of a nerve relative to the vessel.
  • the base temperature is assumed to be the normal body (blood) temperature of 37°C.
  • Horizontal dotted line C represents a critical temperature of about 55°C above which nerve B will begin to sense pain.
  • Curves Dl, D2, D3, D4, D5 and D6 schematically represent the temperature of blood in the vessel at respectively 100.0 microseconds ( ⁇ s), 1.0 milliseconds (ms) 10.0 ms, 100.0, ms, 1.0 second and 10.0 seconds after an irradiation pulse has heated the blood to a maximum temperature of about 90.0°C, which is about the temperature required to cause coagulation.
  • the low absorption of blood for the NIR radiation permits a relatively uniform heating of all blood in the vessel, a characteristic which, as discussed above, has made it attractive for treatment of larger vessels.
  • Curves Dl-6 collectively, schematically illustrate thermal diffusion of heat from the vessel into surrounding tissue, with temperature in the vessel falling and temperature in surrounding tissue rising until an equilibrium is reached at about 10.0 seconds after irradiation. From Curve D4 it can be seen that, in the hypothetical model of FIG. 1, the temperature of nerve B rises above the critical (pain) temperature C about 100.0 ms after the irradiation. From curves D5 and D6 it can be seen that nerve B remains above the critical temperature for a time between about 1.0 and 10.0 seconds.
  • FIG. 2 graphically, schematically illustrates calculated heat distribution as a function of time in a blood vessel heated by a pulse of yellow-green radiation.
  • the graphical axes and the position of vessel- wall A and nerve B are as described above with reference to FIG. 1.
  • Curves El, E2, E3, E4, E5 and E6 schematically represent the temperature of blood in the vessel at respectively 1.0 ⁇ s, 10.0 ⁇ s, 100.0 ⁇ s, 1.0 ms, 10.0 ms and 100.0, ms, after an irradiation pulse has heated the blood to the coagulation temperature of about 90.0°C.
  • the high absorption of blood for the yellow-green radiation causes initial heating and coagulation of the blood to be confined to a depth of about 50 ⁇ m in the vessel.
  • Curves El-6 collectively, schematically illustrate thermal diffusion of heat from the heated portion of the vessel. It can be seen that as a result of the restricted heating volume in the vessel, the temperature at vessel-wall A and accordingly at nerve B, never exceeds the pain-threshold temperature (dotted line C).
  • FIGS 1 and 2 assume, for simplicity of calculation, a radially symmetrical distribution of temperature from the center of the vessel. In reality, irradiation of the vessels causing the heating will come from a particular direction. In the FIG. 1 case, because of the relatively uniform penetration, this "cross- section" representation is believed to provide a reasonable representation of temperature distribution anywhere around a vessel. In FIG. 2, the condition near the Y-axis more accurately represents the condition at that part of the vessel wall on which the radiation is incident.
  • the yellow-green radiation is strongly absorbed by hemoglobin in blood in the vessel, thereby heating the blood and causing the blood to coagulate. Because of the high absorption in the hemoglobin, the penetration depth is short compared with the diameter of the blood vessel. This causes coagulum 30 to form in the vessel. The coagulum has an even higher absorption (attenuation) for the radiation than uncoagulated blood and effectively shields the remaining blood 32 from radiation. The temperature of the remaining blood will increase via heat diffusion from the coagulum but may remain below the temperature required for coagulation.
  • FIG. 4 The situation following stenosis is depicted schematically in FIG. 4.
  • blood vessel 28 of FIG. 3 is depicted in longitudinal cross-section.
  • Vessel-wall 34 in the region of the vessel irradiated by scattered yellow- green radiation 20A has been reduced to about one-half of its original diameter indicated by dotted lines 34A.
  • the volume of uncoagulated blood in the irradiated area is reduced.
  • the volume would be reduced by about a factor of four compared with the volume prior to the shrinkage.
  • the vessel is irradiated with NIR radiation to complete the coagulation initiated by the yellow- green irradiation. This is done either concurrently with the irradiation of blood vessel 28 with yellow-green, or at some interval thereafter, preferably while blood in the vessel is still heated above its normal temperature.
  • the NIR radiation can relatively precisely target the yellow-green irradiated area. Even though the absorption coefficient for NIR radiation may be increased in coagulum 30, penetration of the entire vessel by the NIR radiation is still possible.
  • the absorption coefficient of the NIR for heated but uncoagulated blood in the vessel has been found to be higher than for unheated blood, by a factor of up to about four or five. This provides that the heated blood can be more efficiently heated by the NIR radiation to complete the coagulation. It is believed, without being limited to a particular theory that the increased absorption results from a photoconversion from oxyhemoglobin (in normally flowing blood that has not been irradiated) to methemoglobin, the latter having a higher absorption for NIR wavelengths than the former.
  • a reduced volume of blood to be heated or a higher efficiency of heating blood is responsible for providing that the NIR radiation fluence required to complete coagulation is about one-third or less of that which would be required to complete coagulation if the vessel were not stenosed.
  • Reduced NIR fluence can contribute to a significant reduction in the possibility of pain being felt as a result of the inventive treatment. It is also believed that the stenosis and resultant reduction of blood volume by the yellow-green irradiation may somewhat more effective in reducing the required NIR fluence than the pre-coagulation. This can allow use of a significantly lower yellow-green radiation fluence than would be required for vessel treatment using yellow-green radiation alone.
  • a pulse 40 of yellow-green radiation is delivered to a vessel being treated (see FIG. 5A).
  • the radiation is delivered from a source of narrow spectral linewidth radiation such as a laser, or a gas discharge lamp.
  • the radiation preferably has a wavelength between about 480 and 600 nm and most preferably between about 530 and 590 nm.
  • pulse 40 has a duration T G between about 2.0 ms and 100 ms.
  • Pulse 40 may be delivered as a single continuous pulse or as a burst of shorter, higher-intensity pulses with the burst of pulses having a duration comparable to duration of the single continuous pulse.
  • the total fluence in the pulse 40 or a burst equivalent thereof is preferably between about 8.0 J/cm 2 and 30.0 J/cm 2 .
  • a pulse 42 of NIR radiation is delivered to a vessel being treated (see FIG. 5B).
  • the radiation is preferably delivered from a laser or a gas-discharge lamp.
  • the NIR radiation preferably has a wavelength between 605 and 1350 nm and most preferably between about 605 and 1100 nm.
  • One possible suitable wavelength is about 640 nm. This is a wavelength about which methemoglobin has an absorption peak.
  • pulse 42 has a duration T NIR between about 2.0 ms and 100.0 ms.
  • Pulse 42 may also be delivered as a single, continuous pulse or a sequence of pulses as discussed above.
  • the total fluence in pulse 42 or a sequence of such pulses is preferably between about 10.0 J/cm 2 and 100.0 J/cm 2 and most preferably between about 20 and 80 J/cm 2 .
  • the interval ⁇ T between pulses 40 and 42 is preferably no longer than about two thermal relaxation times for the vessel being treated.
  • the thermal relaxation time of a vessel is proportional to the square of the diameter of the vessel.
  • relaxation times for vessels of about 0.5 mm and 2.0 mm in diameter are about 75.0 ms and 1200.0 ms respectively. It is believed that in order to achieve an optimum synergistic effect of the two different-wavelength pulses of the present invention, the vessel temperature at the instant of delivery of pulse 42 should preferably still be above the normal temperature of about 37° C as depicted in FIG. 5C.
  • an interval ⁇ T of about 100.0 ms or less is believed to be suitable for vessels having a diameter of about 1.0 mm or less.
  • pulses 40 and 42 may be delivered simultaneously consistent with the method of the present invention. Indeed, delivery of pulse 42 may even be initiated before pulse 40 provided there is sufficient overlap of the pulses for a synergistic effect to result. Such temporal arrangements of the pulses are possible when pulse 42 provides a fluence less than would be necessary to have any therapeutic effect in the absence of any heating, stenosis or pre- coagulation of the vessel by yellow-green pulse 40, but has sufficient fluence to complete the coagulation once yellow green-pulse 40 triggers one or more of these effects.
  • one preferred embodiment 50 of apparatus for simultaneously or sequentially delivering yellow-green and NIR radiation pulses in accordance with the present invention includes a yellow green laser 52 and an NIR laser 54.
  • Laser 52 may be any pulsed laser which delivers radiation in the spectral range from about 488 nm to 600 nm.
  • the lasers include control arrangements not shown for varying output parameters thereof such as pulse duration and fluence.
  • suitable lasers for laser 52 include but are not limited to argon lasers, dye lasers, and frequency doubled solid-state lasers such as frequency doubled Nd:YAG or Nd:YVO 4 lasers.
  • Laser 54 may be any pulsed laser which delivers radiation in the spectral range from about 605 to 1350 nm.
  • suitable lasers include but are not limited to ruby lasers, alexandrite lasers, Nd:YAG lasers, Nd:YVO 4 lasers and semiconductor lasers (diode-lasers), or arrays thereof.
  • the lasers are fired by operating a single footswitch 56.
  • Footswitch 56 is connected to a pulse sequencer 57 which determines the order of firing of the lasers and the interval between firings. Methods of synchronizing firing of separate lasers are well known to those skilled in the art and accordingly are not described in detail herein.
  • Laser pulses from lasers 52 and 54 are transported by optical fibers 58 and 60 respectively to handpieces 64 and 62 respectively.
  • Handpieces 62 and 64 include focussing optics and the like (not shown) for focusing or adjusting the spot size of beams delivered thereby.
  • Handpieces 62 and 64 are held by a bracket 66 at an angle to each other. This angle is selected such that beams delivered thereby penetrate skin 69 of a patient being treated and intersect at a point 70 which is arranged to coincident with a vessel to be treated.
  • Apparatus 80 is similar to apparatus 50 inasmuch as it includes yellow- green and NIR lasers 52 and 54 fired in a predetermined sequence with pulses being transported from the lasers by optical fibers 58 and 60.
  • Apparatus 80 includes a composite handpiece 82 including optical systems 84 and 86 connected to optical fibers 60 and 58 respectively.
  • Optical system 86 directs a pulse received via optical fiber 58 along a path indicated by single arrows 87 to a turning mirror 88.
  • Turning mirror 88 redirects path 87 to a dichroic mirror 90 which is reflective for the yellow-green radiation and transmissive for the NIR radiation.
  • Dichroic mirror 90 is arranged to combine path 87 with the path (indicated by double arrows 92) of a NIR-radiation pulse delivered from optical system 84 after being received thereby along optical fiber 60.
  • the combined paths 87 and 92 traverse a cooled, transparent window or chill-tip 94 which can be placed on skin 69 of a patient above a vessel at point 70 to be treated.
  • the form and function of chill tips for cooling a patients skin during treatment are well known in the art. Accordingly a detailed description of such a chill tip is not presented herein. Referring now to FIG.
  • Apparatus 100 includes yellow-green and NIR lasers as 58 and 60 described above. Radiation from yellow-green laser 52 travels along a path 102 via a fold mirror 104 to a dichroic beam combiner 106. At beam combiner 106 the yellow-green radiation is directed along a common (collinear) path 108 with NIR radiation from NIR laser 54.
  • the yellow-green and NIR radiation is focussed by a lens 110 into a common transport fiber 61.
  • Optical fiber 61 is coupled to a handpiece 83, wherein an optical system 85 directs the yellow-green and NIR radiation along a common path 114, through a chill tip 94, to blood vessel 70.
  • Apparatus 100 accordingly allows for a more compact handpiece than apparatus 80, while still providing a collinear path to blood vessel 70 for the yellow-green and NIR radiation.
  • Nd:YAG laser generating light at 1060 nm could be used to generate the NIR pulses.
  • the infrared beam from the Nd:YAG laser could be sent through a doubling crystal located either inside or outside the resonator. Some form of shutter could be used to select between the two different wavelength outputs.
  • the inventive treatment method was investigated in a series of tests on blood vessels (venules and arterioles) in the dorsal skin of rats and Syrian golden hamsters.
  • a flap of the animals' dorsal skin was drawn outward and held by clamps.
  • a 1.0 cm diameter disc was excised from one fold of the flap, thereby exposing vessels in the sub-dermal region of the other side of the flap for irradiation.
  • the exposed region was protected with a window while not being irradiated.
  • the window was removed before irradiations were performed, and the exposed tissue was irrigated with isotonic saline solution to prevent dehydration.
  • VPC ⁇ Coherent® VersaPulse® cosmetic laser
  • This laser is a frequency-doubled Nd:YAG laser providing pulses at a wavelength of 532 nm.
  • Handpiece 64 was a Coherent® VersaSpot-F*" 1 adjustable handpiece with a 3.0 mm spot size. The laser could operate at up to 16 J/cm2 with a pulse duration of 10.0 ms.
  • NIR pulses 1 1064 nm (Nd:YAG) laser was used to provide NIR pulses (laser 54).
  • This laser could be configured to deliver pulses having a predetermined duration from 0.1 to 10.0 ms, with pulse energies up to 10.0 Joules.
  • the output of the laser was collimated by simple telescope optics in handpiece 64 and arranged to bring the laser output to a 3.0 mm diameter spot coincident with that of laser 52. Mode scramblers on both lasers ensured that the delivered spots had "top-hat" beam profiles, simplifying radiant exposure calculations.
  • Laser pulse energies were measured with a power meter. Pulse-sequence timing was measured with an oscilloscope. Physical observation of effects of the treatment were made via a CCD video camera from the same side of the flap as irradiations were made.
  • curves G and H indicate the 532 nm fluence which provides a 50% probability of permanent venule (curve G) and arteriole (curve H) damage as a function of vessel diameter.
  • curves are drawn from previously published data (above-referenced Barton et al. paper) on the effects of 532 nm pulses only.
  • the 1064 ⁇ m fluence required to cause permanent damage of arterioles on the order of 150 ⁇ m in diameter and venules of 200 ⁇ m in diameter was determined to be 42.5 J/cm 2 .
  • Diamonds 100 indicate the fluence of a 532 nm pulse which in combination with a 1064 nm pulse of duration 5.0 ms and having a fluence of 15.0 J/cm 2 caused permanent arteriole damage.
  • Squares 102 indicate the fluence of a 532 nm pulse which in combination with a 1064 nm pulse of duration 5.0 ms and having a fluence of 15.0 J/cm 2 caused permanent venule damage.
  • Inverted triangles 104 indicate the fluence of a 532 nm pulse which in combination with a 1064 nm pulse of duration 5.0 ms and having a fluence of 30.0 J/cm 2 caused permanent arteriole damage.
  • Triangles 106 indicate the fluence of a 532 nm pulse which in combination with a 1064 nm pulse of duration 5.0 ms and having a fluence of 30.0 J/cm 2 caused permanent venule damage.
  • the 15.0 and 30.0 J/cm 2 pulses at 1064 nm were about equally effective.
  • the lower value would be preferred in a treatment to reduce the possibility of pain being felt.
  • the 532 nm and 1064 nm fluences required to cause permanent damage are respectively about one-half and one-third those that would be required for 532 nm and 1064 nm pulses alone. This indicates that the treatment method of the present invention may have a significantly reduced possibility of epidermal damage and other above- discussed side effects compared with prior-art treatments using individual pulses at only one or the other wavelength.
  • the method of the present invention is discussed above primarily with reference to delivering a single pulse of yellow-green radiation followed by a single pulse of NIR radiation.
  • the above-discussed experimental results appear to confirm the effectiveness of this delivery scheme in reducing total fluence required.
  • this delivery scheme is preferred scheme, it should not be considered as limiting.
  • a brief discussion of other possible delivery schemes is set forth below with reference to FIGS 10A, 10B and IOC.
  • FIG. 10A schematically depicts two pulses 40 of yellow-green radiation being delivered followed by two pulses 42 of NIR radiation.
  • FIG. 10B schematically depicts a pulse 42 of NIR radiation being delivered and a pulse 40 of yellow-green radiation being delivered while radiation is still being delivered by the pulse 42. A second pulse 42 of NIR radiation may be used to complete coagulation.
  • FIG. 10C schematically depicts two pulses 40 of yellow green radiation being delivered with a pulse 42 of NIR radiation being delivered partially concurrent with and following delivery of the last pulse 42. It is preferable that any sequence of pulses delivered in lieu of a single pulse collectively has a lower fluence than would be necessary to complete coagulation.
  • a method of treating vascular disorders in which a blood vessel is treated by delivering electromagnetic radiation thereto having a wavelength in a range between about 480 nm and 600 nm, and, within a selected time period following initiation of this delivery, delivering electromagnetic radiation thereto having a wavelength in a range between about 605 nm and 1350 nm.
  • the delivery of the shorter and longer wavelength radiations may be at least partially concurrent.
  • the shorter wavelength radiation conditions the blood vessel for complete coagulation of blood therein by the longer wavelength radiation.
  • fluences required to cause permanent damage are respectively about one-half or less and one-third or less than those that would be required using respectively the shorter and longer wavelengths alone.
  • Conditioning by the shorter wavelength radiation reduces the total radiation fluence at the longer wavelength required to complete coagulation of blood in the vessel.
  • Any one or more of three possible factors may contribute to the conditioning.
  • the first possible factor is a stenosis or shrinking of the vessel.
  • the second possible factor is a pre- coagulation of blood in the vessel, which can take the form of a clot of coagulated blood (coagulum) in the vessel.
  • the third possible factor is the heating or photochemical modification of the blood in the vessel by the shorter wavelength pulse or pulses.
  • the first and second factors contribute to reducing the volume of blood to be coagulated. This proportionately reduces the fluence at the second wavelength compared with that which would be necessary to complete coagulation in the absence of the volume reduction.
  • the second and third factors can contribute to increasing the efficiency of coagulation of blood in the preconditioned vessel by the longer wavelength radiation. Any one or both of two effects can contribute to this increased efficiency.
  • the first effect is a preheating of the blood by the shorter wavelength radiation. This is effective in itself inasmuch as less of the longer wavelength radiation is required to raise the temperature of blood in the vessel to the coagulation temperature.
  • the second effect is an increased absorption of the longer wavelength radiation in heated or photochemically modified blood compared with unheated blood.
  • a time interval for delivering the longer wavelength radiation relative to delivery of the shorter wavelength radiation the following should be considered.
  • Stenosis occurs essentially instantaneously, but the stenosed condition of the blood vessel will return to a normal condition in a period from about one to twenty-four hours or more if another pulse or radiation of any wavelength is not delivered to the vessel.
  • a clot coagulum resulting from the delivery of the shorter wavelength radiation will be cleared by blood flow through the vessel in a period ranging from a few hundred milliseconds to a minute or more, depending on vessel size.
  • Cooling of preheated blood occurs in a time period from about tens of milliseconds to a second or more, dependent on blood vessel diameter as discussed-above.
  • the time interval between delivery of the shorter and longer wavelengths must be short enough to take advantage of the thermal effects and is accordingly preferably no greater than about two thermal relaxation times for a targeted blood vessel.
  • a period of up to a few hundred milliseconds could allow one or both of the pre-coagulation and volume reduction effects to be effective.
  • a period as long as an hour or more may still provide some synergistic effect from the volume reduction effect alone.

Abstract

Méthode de traitement de troubles vasculaires qui consiste à exposer un vaisseau sanguin présentant un état anormal à deux impulsions de rayonnement électromagnétique. L'une des impulsions possède une longueur d'onde plus longue que l'autre. L'impulsion de plus grande longueur d'onde est envoyée simultanément ou relativement peu de temps après l'impulsion de longueur d'onde plus courte. Aucune de ces deux impulsions ne produit une fluence suffisante pour endommager irrémédiablement le vaisseau si elle est utilisée seule. Lorsque les impulsions sont utilisées en combinaison, le vaisseau passe, sous l'influence de l'impulsion de plus courte longueur d'onde, à un état dans lequel la coagulation du sang dans le vaisseau et des dommages irrémédiables au vaisseau peuvent être provoqués par la seconde impulsion.
PCT/US2001/006061 2000-03-30 2001-02-26 Traitement de troubles vasculaires au laser a deux longueurs d'ondes WO2001074265A1 (fr)

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WO2004069071A2 (fr) * 2003-02-03 2004-08-19 Alcon, Inc. Illuminateurs a diametre variable du point d'impact, a homogeneite et a parafocalite renforcees
US7255560B2 (en) 2002-12-02 2007-08-14 Nomir Medical Technologies, Inc. Laser augmented periodontal scaling instruments
WO2007118246A1 (fr) * 2006-04-07 2007-10-18 The General Hospital Corporation Procédé, système et dispositif de traitement dermatologique et de relissage cutané fractionnel
WO2008095176A1 (fr) * 2007-02-01 2008-08-07 Candela Corporation Mélange de longueur d'onde de faisceau lumineux pour diverses maladies dermatologiques
US7470124B2 (en) 2003-05-08 2008-12-30 Nomir Medical Technologies, Inc. Instrument for delivery of optical energy to the dental root canal system for hidden bacterial and live biofilm thermolysis
EP2288307A1 (fr) * 2008-05-15 2011-03-02 CeramOptec GmbH Procédé/dispositif pour un traitement vasculaire transdermique
US8506979B2 (en) 2002-08-28 2013-08-13 Nomir Medical Technologies, Inc. Near-infrared electromagnetic modification of cellular steady-state membrane potentials
GB2512585A (en) * 2013-04-01 2014-10-08 Lumenis Ltd Medical laser apparatus
US9351792B2 (en) 2003-03-27 2016-05-31 The General Hospital Corporation Method and apparatus for dermatological treatment and fractional skin resurfacing
WO2018053241A1 (fr) * 2016-09-16 2018-03-22 Boston Scientific Scimed, Inc. Traitement laser à double longueur d'onde

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Publication number Priority date Publication date Assignee Title
US8506979B2 (en) 2002-08-28 2013-08-13 Nomir Medical Technologies, Inc. Near-infrared electromagnetic modification of cellular steady-state membrane potentials
US7255560B2 (en) 2002-12-02 2007-08-14 Nomir Medical Technologies, Inc. Laser augmented periodontal scaling instruments
WO2004069071A3 (fr) * 2003-02-03 2004-11-25 Alcon Inc Illuminateurs a diametre variable du point d'impact, a homogeneite et a parafocalite renforcees
WO2004069071A2 (fr) * 2003-02-03 2004-08-19 Alcon, Inc. Illuminateurs a diametre variable du point d'impact, a homogeneite et a parafocalite renforcees
US9351792B2 (en) 2003-03-27 2016-05-31 The General Hospital Corporation Method and apparatus for dermatological treatment and fractional skin resurfacing
US7470124B2 (en) 2003-05-08 2008-12-30 Nomir Medical Technologies, Inc. Instrument for delivery of optical energy to the dental root canal system for hidden bacterial and live biofilm thermolysis
WO2007118246A1 (fr) * 2006-04-07 2007-10-18 The General Hospital Corporation Procédé, système et dispositif de traitement dermatologique et de relissage cutané fractionnel
WO2008095176A1 (fr) * 2007-02-01 2008-08-07 Candela Corporation Mélange de longueur d'onde de faisceau lumineux pour diverses maladies dermatologiques
EP2288307A1 (fr) * 2008-05-15 2011-03-02 CeramOptec GmbH Procédé/dispositif pour un traitement vasculaire transdermique
EP2288307A4 (fr) * 2008-05-15 2011-06-15 Ceramoptec Gmbh Procédé/dispositif pour un traitement vasculaire transdermique
GB2512585A (en) * 2013-04-01 2014-10-08 Lumenis Ltd Medical laser apparatus
GB2512585B (en) * 2013-04-01 2015-12-02 Lumenis Ltd Medical laser apparatus
WO2018053241A1 (fr) * 2016-09-16 2018-03-22 Boston Scientific Scimed, Inc. Traitement laser à double longueur d'onde
CN109715102A (zh) * 2016-09-16 2019-05-03 波士顿科学医学有限公司 双波长激光治疗

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