Back to Search
Start Over
Catheter-based percutaneous myocardial laser revascularization in patients with end-stage coronary artery disease
- Source :
- Journal of the American College of Cardiology. 34:1663-1670
- Publication Year :
- 1999
- Publisher :
- Elsevier BV, 1999.
-
Abstract
- OBJECTIVESThis study evaluates the feasibility and safety of a catheter-based laser system for percutaneous myocardial revascularization and analyses the first clinical acute and long-term results in patients with end-stage coronary artery disease (CAD) and severe angina pectoris.BACKGROUNDIn patients with CAD and intractable angina who are not candidates for either coronary artery bypass grafting (CABG) or percutaneous transluminal coronary angioplasty (PTCA), transmyocardial laser revascularization (TMR) has been developed as a new treatment that results in reduced angina pectoris and increased exercise capacity. However, surgical thoracotomy is required for TMR with considerable morbidity and mortality.METHODSA catheter-based system has been developed that allows creation of laser channels in the myocardium from within the left ventricular cavity. Laser energy generated by a Holmium: YAG (Cardiogenesis Corporation, Sunnyvale, California) laser was transmitted to the myocardium via a flexible optical fiber capped by an optic lens. The optical fiber was maneuvered to the target area under biplane fluoroscopy through a coaxial catheter system permitting movement in three dimensions.RESULTSThirty-four patients with severe CAD not amenable to either CABG or PTCA and refractory angina pectoris (Canadian Cardiologic Society [CCS] Angina Scale Class III–IV) were included in the study. Ischemic regions were identified by coronary angiography and confirmed by thallium scintigraphy. The percutaneous myocardial revascularization (PMR) procedure was successfully completed in all patients. In 29 patients, one vascular territory of the left ventricle and in 5 patients, two vascular territories were treated. Eight to fifteen channels were created in each ischemic region. Major periprocedural complications were limited to an episode of arterial bleeding requiring surgical repair. There was one death early after PMR, due to a myocardial infarction (MI) in a nontreated region. Clinical follow-up at 6 months (17 patients) demonstrated significant improvement of angina pectoris (CCS class before PMR: 3.0 ± 0.0, six months after PMR: 1.3 ± 0.8, p < 0.0001) and increased exercise capacity (exercise time on standard bicycle ergometry before PMR: 384 ± 141 s, six months after PMR: 514 ± 158 s, p < 0.05), but thallium scintigraphy failed to show improved perfusion of the laser treated regions.CONCLUSIONSPercutaneous myocardial revascularization is a new safe and feasible therapeutic option in patients with CAD and severe angina pectoris not amenable to either CABG or PTCA. Initial results show immediate and significant improvement of symptoms and exercise capacity but evidence of improved myocardial perfusion is still lacking.
- Subjects :
- Male
Cardiac Catheterization
medicine.medical_specialty
Percutaneous
medicine.medical_treatment
Coronary Disease
Pilot Projects
Coronary Angiography
Revascularization
Angina Pectoris
Angina
Coronary artery disease
Internal medicine
Myocardial Revascularization
medicine
Humans
cardiovascular diseases
Myocardial infarction
Aged
Cardiac catheterization
Aged, 80 and over
Ejection fraction
business.industry
Middle Aged
medicine.disease
Surgery
Catheter
Treatment Outcome
Cardiology
Feasibility Studies
Female
Laser Therapy
Cardiology and Cardiovascular Medicine
business
Subjects
Details
- ISSN :
- 07351097
- Volume :
- 34
- Database :
- OpenAIRE
- Journal :
- Journal of the American College of Cardiology
- Accession number :
- edsair.doi.dedup.....353523f842ea12b53c8ae46342209984