Dr.

Jose Hernandez Fujigaki: the modality that going to be thats already applied
by the clinitian, the cardiolo the invasive vascular interventionist. They are
already doing these things. And its a combination of many patients will need
only the laser, I would say and then observation, then maybe repeat the laser. And
some other patients will need a combination of surgery and laser or only surgery
depending.

I think every case is different because there are so many variabilities in the
anatomy, and the clinical presentation of the patient

Interviewer: What was it that got you excited about this new technology, where
you said, Dean we really want to do this here, we want to try this here

Dr. Jose Hernandez Fujigaki: Well, first because I think treatment with laser is,
its one of the modalities of therapy, in the patients with have peripheral vascular
disease. In the that was the main reason, the new modality, relatively they mean
adapting different types of lasers, in different ways to approach the area, to open
the vessels

And I think Dean has been pioneering with this speciality with deciding the
characters and producing the right type of lasers that is needed to open in simple
ways the obstructions in the vessels. And based on that, I thought that we have the
facility and we have some patients that have these problems that were not
amendable through surgical intervention.

And then, we collected a few patients, and they were kind enough to come with all
the technology, and me being a cardiovascular surgeon, I did not do the cases
directly. It was the doctor, the previous one, Mr. Rodriguera, and another doctor
from San Diego, who came I think from

Interviewer: University of California, San Diego (UCSD).

Dr. Jose Hernandez Fujigaki: University of California, San Diego (UCSD). In a

combination, they work, and I was just watching on the side-lines.

Interviewer: So, you observed the process and I am curious what was the result? In
your experience in observing the use of the laser, how did that differ from the use
of other technologies in terms of the process as well as the result?

Dr. Jose Hernandez Fujigaki: The well I was surprised how easy it was to open
and complete the [inaudible 02:54:00]. It took just a few minutes to go through and
when you look at the angiogram, it looks almost normal inside the endothelium,
inside the lumen of the vessel. And I was surprised that it was relatively a simple
procedure.

Obviously, all those patients need follow up to see how they do, if they still keep
open for how long, you know, how much they decrease symptoms. Everything
seems to be well in [inaudible 03:24:00], they need more patients, more data.

I was [inaudible 03:28:00] surprised, the difference between the laser and the
surgery. The surgery is more invasive, obviously we have to cut the patient, and the
limbs, the lower limbs is not that difficult because is not that deep the vessel and
we can do the bypass.

But once it gets higher into the abdomen, its more difficult to do this kind of
procedures, more invasive. And obviously the recovery of the patient will be
much most we will watch that more simple.

Interviewer: talk about the recovery of patient, in the use of the laser versus some
of the other devices out there.

Dr. Jose Hernandez Fujigaki: in the patients that we saw here, we the patients
did very well, as a precaution, we decided to keep the patients overnight and watch
them and let them go the following morning. In the future, when there are more
patients, and probably they have more data, this could be even done as an outpatient procedure.

But I am talking about the lower limbs, which is the most affected with peripheral
vascular disease.

Interviewer: and thats not typical?

Dr. Jose Hernandez Fujigaki: thats not no, for the surgical intervention, usually
we will let them go between 24 to 72 hours after the surgery. We dont do it as an
out-patient
Interviewer: So prior to using or when youre not using this laser here at the
hospital, how often do these patients end up with peripheral artery disease? End up
in your hands? because a device from the interventional cardiologist is not
working, you end up having to bypass surgically?

Dr. Jose Hernandez Fujigaki: That is an interesting question because interventional

vascular surgeries not only do laser this is one of the latest modalities. Before they
did angioplasties

Interviewer: right

Dr. Jose Hernandez Fujigaki: they put a balloon and dilate the vessel, and now they
do stentings. They put stent inside and deploy it, inflating a balloon and that way
they open the lumen.

I could say that we need a lot of data, clinical data to see but it looks more
simplistic and without leaving any gadgets inside the vessels to open. The question
is, you know, how the endotheliums reform inside the vessel? And how long it
stays open? And the data on the patients that are coming, they continue to do well.

Probably some of them needed to be restarted, to see how the malformity of the
vessel looks.

Interviewer: what are advantages of not using stents?

Dr. Jose Hernandez Fujigaki: They are

Interviewer: because so far with these patients that have used, in which the laser
was used, no stents were put in.

Dr. Jose Hernandez Fujigaki: They one of the advantages, that you do not have a
foreign body inside of you. That is one, one important issue. The other issue could
be the cost. I am not an expert in that area, probably the people who produce
things. But probably with the laser it will less expensive. Stents are very expensive.

And I dont know, lasers probably come down price. The catheters, many of
most of them are will be disposable catheters. You use them once and discard them.

Interviewer: is there anything else that you have observed with these, the lasers and
your desire to have one at the hospital, you will like to add?

Dr. Jose Hernandez Fujigaki: well, number one, I was surprised at how simple they
open the vessels and in long obstructions, usually a vessel when you have a
vessel, you have several possibilities. You have years, you know, stricture that is
limited to quarter of an inch. Sometimes, you know, half an inch or one inch. And
it could be a total or subtotal occlusion. With total occlusion, the only thing that
could work is the laser.

Because they open the lumen, they cannot do, they are interventional procedures.
They could try probably but its more difficult. Like [inaudible 07:39:00] later and
then put a catheter, then dilate, then stenting or whatever. And the laser, its just, its
opens slow steadily and relatively fast. Thats why I was impressed. When I did
the angio in the last 2 or 3 procedures, I was not in the lab, but I saw the finish.

And I, I was really pleased to see how looks normal, when you used to look at the
vessel, looks normal. When you do stentings, you always will see [inaudible
00:08:09] those things that are there. I think its the procedure that is going to have
great application in the clinical field. And is proved by different companies that is
trying to get into this market and I think Dean is one of the pioneers.
[inaudible 00:08:30] we are happy that he is closeby here in San Diego and we
became kind of friends now that we have been working and this laser.

Interviewer: so you can envision other use cases for this type of laser?

Dr. Jose Hernandez Fujigaki: Yeah, I wouldsay in cardiology it could be a great

application, cardiology. Like the one they started with stenting, they have tried, at
the beginning when they tried to, to do the angioplast in the heart. One of my
works at that time was standby. They dilated one vessel or the other was standing
by, they couldnt open the vessel, we took them to surgery.

And probably something similar could be on the laser, yeah. Or the interventional
cardiologist have become more skilful because they do so many now a days with
little variations, probably will be an application specially for total occlusions.

Because the other ones will be difficult, its so many, I think like a million cases a
year for stenting and angioplasties, and a million cases, close to, a little bit less but
close to a million for surgery and angioplasties in the United States.

And lasers is not that many or have at least, I havent been that close following
those things lately but I dont know if do have doing lasers or not. But do you
know that the if they are doing any lasers in the coronaries?

Producer: yes, yes they do it at several hundred sites in the last year.

Dr. Jose Hernandez Fujigaki: okay, well that I dont follow anymore I am just on
the stenting, we are in hidden south of the border, we only do stentings and
angioplasts, we dont do lasers

Producer: yes sir

Dr. Jose Hernandez Fujigaki: in that in the, if its an application probably would be
a good exploration

Interviewer: do you see this laser as being a difference between life and death for
some patients?

Dr. Jose Hernandez Fujigaki: when were talking about extremities, its more than
life and death, its having your limb or not having your limb. Of course, it can make
a difference. If the vessel is still occluded, the more distant the vessel that gets
occluded, the more in jeopardy your extremity is.

Thats if you include the distal vessels below the knee, especially in a diabetic
patient. Its [inaudible 00:10:55] possibility that sooner or later you going and lose
your extremity and [inaudible 00:11:01] it can be life-saving this procedures. More
than life saving, you know, because we can prevent this, we can proceed to an
amputation, but more than that, you know, you will be able to walk without a
prosthesis.

And I will have, the patient have his or her legs

Interviewer: perfect. Did we get all the
Producer: Great, yeah

Interviewer: the questions?

Dr. Jose Hernandez Fujigaki: okay

Producer: can you, can you

Dr. Jose Hernandez Fujigaki: Sorry, I didnt know much about the laser lately on
that area because I am concentrated now on the just the cardiac surgery

Producer: can you just get . I want to make sure I get your questions just clean,
just on this camera?

Interviewer: I dont know my questions were then

Producer: oh okay, but what about your first question?

Interviewer: what did I ask in my first question? Oh boy,

Producer: thats okay
Interviewer: I think it was, what was it in terms of this laser that , boy, what did I
ask, something about bringing the laser here? Why did you want to

Dr. Jose Hernandez Fujigaki: Yeah, that was your second or third question

Interviewer: what made you want to

Producer: lets just, let me just go through just a couple of questions because I want
to make sure I get them clean cause I want to remove two shots, to make sure I get
them clean, from your angle.
Interviewer: okay
Producer: okay
Interviewer: what was it about Dean and Ron medical, and the prospects of this
laser, that made you want your hospital to be a test bed for this technology?

Dr. Jose Hernandez Fujigaki: probably because that

Producer: thats fine and then any other questions we should go through?

Interviewer: the one about do you see this technology as making a difference or
being the difference between life and death, or limb and no limb

Producer: great

Dr. Jose Hernandez Fujigaki: of course this is a procedure that the..