Abstract: Fiber delivered laser pulses emulsify thrombus by mechanical stresses that include a combination of pressure, tension and shear stress. Laser radiation is delivered to the locality of a thrombus and the radiation is absorbed by blood, blood dot, or other present materials. The combination of a leading pressure wave and subsequent vapor bubble cause efficient, emulsification of thrombus. Operating the laser in a low average power mode alleviates potential thermal complications. The laser is operated in a high repetition rate mode to take advantage of ultrasound frequency effects of thrombus dissolution as well as to decrease the total procedure time. Specific parameter ranges for operation are described. The device includes optical fibers surrounding a lumen intended for flow of a cooling agent. The fibers may be arranged concentrically around the lumen to deliver radiation and heat over as large an area as possible.