surgical sapphire

Carotid occlusive disease is responsible for a significant proportion of major adverse cardiovascular events (death, stroke, myocardial infarction). Effective prevention by means of revascularization is a sufficient treatment, if performed at a center with an acceptably low procedural complication rate. Carotid surgery is the currently accepted standard of treatment for revascularization of extra cranial carotid occlusive disease. This has been validated by randomized clinical trials that have demonstrated its efficacy over best medical therapy...

PURPOSE: The efficacy of two types of contact transscleral Nd:YAG laser delivery systems, a synthetic sapphire-tipped laser probe connected to a Surgical Laser Technologies (SLT) laser and a quartz fiberoptic tip connected to a LASAG Microrupter III, was compared. METHOD: A total of nine pigmented rabbits underwent transscleral LASAG cycloablation in one eye (3.2 W, 0.5 s); an additional eight rabbits underwent Surgical Laser Technologies cycloablation (3.0 W, 0...

The review provides an update on the surgical management of branch retinal vein occlusion. Arteriovenous sheathotomy is shown to be the only clinically evaluated and approved technique for surgical decompression of occluded retinal vein; it is based on indirect mechanical effect of reducing external vascular compression to improve the blood flow. Despite visual improvement in some patients, capillary reperfusion was not always achieved. Results of our own experimental studies are described to substantiate the use of a low-energy near-infrared Ti:Sapphire femtosecond laser for direct non-mechanical destruction of thrombotic material to immediately restore the blood flow in retinal vein...

Carotid endarterectomy (CEA) is a well-established surgical treatment for carotid artery stenosis. Carotid artery stenting (CAS) is a preferred treatment strategy in high-risk patients requiring surgery. Lacunar stroke has been the most prevalent stroke type among the Japanese. Recently carotid artery atherosclerotic thrombosis cases have been more frequently in Japan. Poor of CAS results are obtained with thrombo-embolic complications. Distal protection devices have been developed to avoid such complications...

BACKGROUND AND PURPOSE: Various imaging modalities are under investigation for real-time tissue imaging of periprostatic nerves with the idea of improving the results of nerve-sparing radical prostatectomy. We explored multiphoton microscopy (MPM) for real-time tissue imaging of the prostate and periprostatic neural tissue in a male Sprague-Dawley rat model. The unique advantage of this technique is the acquisition of high-resolution images without necessitating any extrinsic labeling agent and with minimal phototoxic effect on tissue...

OBJECTIVE: Carotid endarterectomy (CEA) is the standard treatment of carotid stenosis for symptomatic and asymptomatic patients. Carotid angioplasty and stenting (CAS), however, has been proposed as alternative therapy for patients deemed at high-risk for CEA. This study examined 30-day adjudicated outcomes in a contemporary series of CEAs and assessed the validity of criteria used to define a potential high-risk patient population for CEA. METHODS: Patients undergoing isolated CEA in private sector hospitals between Jan 1, 2005, and Dec 31, 2006, were identified using the prospectively gathered National Surgical Quality Improvement Program database...

The SAPPHIRE trial has established carotid artery stenting (CAS) in high-surgical-risk patients as an effective alternative to carotid endarterectomy. Since the occurrence of distal embolization with CAS is still a major concern, an embolus protection device is usually employed during the procedure. Although the advantage of the filter device is continuation of blood flow during the procedure, blood flow is occasionally reduced due to plaque debris or thrombus. Here, we report a case of internal carotid artery (ICA) stenosis complicated with filter obstruction during CAS...

BACKGROUND: Previously, the Stenting and Angioplasty with Protection of Patients with High Risk for Endarterectomy (SAPPHIRE) randomized trial showed that carotid artery stenting (CAS) was not inferior to carotid endarterectomy (CEA) in the treatment of high-surgical risk patients. OBJECTIVE: The primary objective of the SAPPHIRE Worldwide Registry is to evaluate 30-day major adverse events (MAE) after CAS performed by physicians with varied experience and utilizing a formal training program...

PURPOSE: To evaluate whether corneal flaps can be generated by the 80 MHz near-infrared, intense nanojoule femtosecond laser based on multiphoton absorption. METHODS: A solid-state Ti:Sapphire femtosecond laser system was integrated in an inverted JenLab Femt-O-Cut laser scanning microscope. A diffraction-limited 40x objective was used to induce multiphoton ionization and plasma production. New Zealand albino rabbits and porcine eyes were used. Surgical outcomes were determined using frame and line scans with nanojoule pulses at a wavelength of 800 nm...

PURPOSE: The femtosecond laser has been realized as an advantageous tool for micromachining, and the feasibility of employing it for surgical procedures has been investigated. A prior study demonstrated dose-dependent femtosecond laser photodisruption of peripheral corneal tissue through a gonioscopic lens in enucleated porcine eyes and of the trabecular meshwork (TM) in human corneoscleral rim tissues, with little collateral damage. The present study was undertaken to extend these efforts to ex vivo primate eyes...

BACKGROUND: We previously reported that, in a randomized trial, carotid stenting with the use of an emboli-protection device is not inferior to carotid endarterectomy for the treatment of carotid artery disease at 30 days and at 1 year. We now report the 3-year results. METHODS: The trial evaluated carotid artery stenting with the use of an emboli-protection device as compared with endarterectomy in 334 patients at increased risk for complications from endarterectomy who had either a symptomatic carotid artery stenosis of at least 50% of the luminal diameter or an asymptomatic stenosis of at least 80%...

Precise laser surgery is possible with laser pulses at wavelengths that are strongly absorbed at the surface of tissue. However, pulses at these wavelengths (far UV, far infrared) are not compatible with fiber-optic transmission, making endoscopic surgical procedures inside the body difficult. We use evanescent optical waves to demonstrate an alternative for confining energy near the tissue surface. Precise, superficial tissue ablation is achieved with evanescent waves generated at a sapphire-tissue interface by a free-electron laser, where the ablation depth may be varied...

OBJECTIVES: To describe the failure of one case of suburethral tape for the correction of the stress urinary incontinence with the multifilament Sapphire VS (vaginal-suprapubic approach) system after 34 months of good outcome. METHODS: Description of the case and its resolution. RESULTS: The patient presented with a descent of the lateral fixation and erosion of the vaginal mucosa with exposure of the mesh and infection. The silicone fixation system, which was loose, was retrieved very easily and a new suburethral mesh with the system TVT-O was inserted; the patient recovered continence as before...

OBJECTIVES: The objectives of this study were to determine the results of a specific technique in the performance of carotid endarterectomy (CEA) and to compare results using this technique between standard-risk and high-risk patients eligible for Stenting and Angioplasty with Protection in Patients at High Risk for Endarterectomy (SAPPHIRE) and between asymptomatic and symptomatic patients. METHODS: A total of 391 patients underwent 442 consecutive CEA procedures under general anesthesia with the intent to shunt, patch, and perform intraoperative completion duplex ultrasound imaging...

BACKGROUND AND OBJECTIVE: Multiphoton microscopy/tomography has been used as a novel diagnostic method for corneal imaging with subcellular resolution. Here, we used this technique to monitor femtosecond laser intratissue surgery effects. MATERIALS AND METHODS: Multiphoton microscopy/tomography on rabbits based on intense 90 MHz femtosecond Ti: sapphire laser was realized at intensities of MW-GW/cm(2), whereas the surgical procedures were performed with the same system at a higher light intensity on the order of TW/cm(2)...

OBJECTIVE: This study examined whether physicians with varying carotid stent experience would obtain safety and efficacy outcomes as good as those from the pivotal SAPPHIRE trial following participation in a comprehensive carotid stent training program. BACKGROUND: This study was performed as a condition of approval study for the PRECISE(R) Nitinol Stent and the ANGIOGUARD XP Emboli Capture Guidewire. METHODS: Patients at high surgical risk who were either symptomatic with >or=50% stenosis or asymptomatic with >or=80% stenosis of the common or internal carotid artery received carotid artery stenting with distal emboli protection using the PRECISE Nitinol Stent and the ANGIOGUARD XP Emboli Capture Guidewire...

Ischemic stroke threatens public health dramatically, and demographic changes promise to continue this epidemic. Although medical advances in risk factor modification, hypertensive control, and antiplatelet therapy have mitigated morbidity and mortality of cerebrovascular disease somewhat, stroke still costs billions in healthcare dollars and reduces quality of life for many patients immeasurably. Carotid endarterectomy has been the standard for invasive management of carotid atherosclerosis, successfully reducing risk of stroke in asymptomatic and symptomatic patients...

PURPOSE: To evaluate ultrahigh resolution optical coherence tomography (UHR OCT) for visualization of intraretinal layers, especially the photoreceptor inner segment and outer segment layers, in eyes with macular holes and after surgical intervention. METHODS: An UHR OCT system based on a titanium:sapphire laser was used, enabling in vivo cross-sectional retinal imaging with 3-micro m axial resolution. Typical, representative tomograms of 5 of 48 eyes from 36 patients demonstrated the potential of UHR OCT to detect morphologic changes in different stages of full-thickness macular holes and changes induced by surgical intervention...

BACKGROUND AND PURPOSE: Transfemoral carotid stenting, despite becoming very frequent, has some limitations such as difficult groin access in few patients, lack of distal protection during filter placement, or embolization despite protection. Transcervical stenting (TCS) is a novel technique during which a common carotid to jugular vein shunt is placed creating a protective reversal flow in the internal carotid artery after proximal common carotid artery (CCA) clamping. We aim to study, with transcranial Doppler (TCD), cerebral flow changes and microemboli detection during transcervical stenting...

Multiphoton microscopy including multiphoton autofluorescence imaging (MAI) and second-harmonic generation (SHG) is being used as a novel diagnostic tool to perform tissue nonlinear optical tomography with submicron resolution. The three-dimensional corneal ultrastructure of whole depth has been viewed without any staining or mechanical slicing. Compared with photodisruptive surgical effects occurring at TW/cm2 light intensity, multiphoton imaging can be induced at MW-GW/ cm2 photon intensity. The intratissue surgical effect including nanojoule (nJ) femtosecond laser ablation and flap generation was induced through multiphoton nonlinear absorption at a wavelength of 800 nm and ascertained by the histological outcomes...