The investigational solid-state, pulsed-wave, mid-infrared (2.1 microns) holmium:YAG laser can be applied for plaque ablation and thrombus dissolution. A multicentre study reports 87% laser success and 94% final procedural success. It has established the safety and efficacy of this laser in ischaemic syndromes and acute myocardial infarction treating lesions considered 'not ideal' for balloon angioplasty. These include thrombotic occlusions, total occlusions, calcified obstructions, de novo and restenosis lesions within native coronary arteries and saphenous vein grafts. Unfortunately, the laser does not significantly reduce restenosis rate. Processes related to laser-tissue interactions such as gas vapour formation and generation of acoustic waves with tremendous intraplaque pressures mandate application of appropriate lasing technique to ensure clinical success.