The laser guidewire experience: 'crossing the Rubicon'.

Despite continued improvements in mechanical hardware for coronary angioplasty, chronic total occlusions (CTO) remain a true challenge in the field of interventional cardiology. Therefore, new guidewire technology, which made use of the unique forward debulking properties of excimer laser light, was designed and introduced into clinical practice in 1993. After an initial pilot-study phase, a European Multicenter Surveillance Study was initiated to evaluate the performance of the new laser guidewire. A short overview is given of the incidence of CTO. The limitations of the percutaneous treatment with various mechanical guidewires and the clinical and angiographic follow-up of CTO are discussed. Furthermore, the initial experience with the laser guidewire during the pilot-phase and preliminary results of the European Multicenter Surveillance Study are presented. At the introduction of yet another new (and costly) device, the key question is: 'Yes, but does it allow us to expand the battle field of interventional cardiology?'