The acute effect of increased laser energy during the excimer laser-assisted non-occlusive anastomosis procedure on the vessel wall of the recipient artery: A histopathological study

Authors

  • Matthijs Biesbroek MSc,

    1. Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
    2. Department of Neurosurgery, Rudolph Magnus Institute of Neuroscience, University Medical Center Utrecht, Utrecht, The Netherlands
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  • Tristan P.C. van Doormaal MD, PhD,

    1. Department of Neurosurgery, Rudolph Magnus Institute of Neuroscience, University Medical Center Utrecht, Utrecht, The Netherlands
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  • Albert van der Zwan MD, PhD,

    1. Department of Neurosurgery, Rudolph Magnus Institute of Neuroscience, University Medical Center Utrecht, Utrecht, The Netherlands
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  • Cornelis A.F. Tulleken MD, PhD,

    1. Department of Neurosurgery, Rudolph Magnus Institute of Neuroscience, University Medical Center Utrecht, Utrecht, The Netherlands
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  • Luca Regli MD, PhD,

    1. Department of Neurosurgery, Rudolph Magnus Institute of Neuroscience, University Medical Center Utrecht, Utrecht, The Netherlands
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  • Harry F.G. Heijnen PhD,

    1. Department of Clinical Chemistry and Hematology, University Medical Center Utrecht, Utrecht, The Netherlands
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  • Aryan Vink MD, PhD

    Corresponding author
    1. Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
    • University Medical Center Utrecht, Department of Pathology, Heidelberglaan 100, Room H04-312, 3584 CX Utrecht, The Netherlands.
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Abstract

Background and Objective

The excimer laser-assisted non-occlusive anastomosis (ELANA) technique is a way of making an anastomosis of vessels without temporal occlusion that is used for cerebral revascularization. Currently, 10 mJ of laser energy is used during the ELANA procedure. We have recently demonstrated that increasing the laser energy may increase flap retrieval rate. The aim of the present study was to study the acute effect of increased laser energy during the ELANA procedure on the recipient vessel wall.

Materials and Methods

The ELANA technique was performed on the abdominal aortas of rabbits under anesthesia using three categories of laser energy (two laser episodes of 10, 13, and 15 mJ, respectively). The rabbits were subsequently sacrificed and the anastomoses were removed. A non-lased rabbit aorta was used as control. Recipient arteries were studied using histopathology and transmission electron microscopy.

Results

In all three categories of laser energy and in the control group, the tunica media and adventitia adjacent to the anastomosis were intact, apart from damage caused by sutures. In the control group, the endothelium was fully intact. In the 10 and 13 mJ subgroups, the endothelium was mostly intact [92% (range 85–98) and 87% (range 80–90) for 10 and 13 mJ, respectively]. In the 15 mJ subgroup, most of the endothelium was absent [32% (range 20–40) of endothelium intact], predominantly at the side opposed to the anastomosis.

Conclusion

Increasing the laser energy during the ELANA procedure from 10 to 13 mJ does not cause additional acute damage to the vessel wall. Increasing the laser energy from 13 to 15 mJ results in increased acute damage of the endothelium, whereas tunica media and adventitia remain unaffected. Further studies are required to assess the long-term effects of increased laser energy during the ELANA technique. Lasers Surg. Med. 43:522–527, 2011. © 2011 Wiley-Liss, Inc.

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