Percutaneous myocardial laser-revascularization. A new therapy for patients with end-stage coronary heart disease and refractory angina pectoris

Background and objectives: In patients with intractable angina because of e nd-stage coronary artery disease, transmyocardial laser revascularization ( TMR) leads to improvement of angina pectoris and increased exercise capacit y. However, surgical thoracotomy is required for TMR with considerable morb idity and mortality. Therefore, a catheter-based laser system has been deve loped which allows to create laser channels into the myocardium from the le ft ventricular cavity. Patients and methods: 46 patients (38 m, 8 f) with refractory angina pector is due to severe coronary artery disease were treated with "percutaneous my ocardial laser revascularisation" (PMR). Clinical parameters (severity of a ngina pectoris, use of additional nitroglycerin) and results of non-invasiv e tests (exercise-ECC, echocardiography, thallium-scintigraphy) were analys ed at baseline and 3, 6 and 12 months after PMR. Results: The PMR procedure was successfully completed in all patients. In 3 0 patients, one region (anterior, lateral, inferior) of the left ventricle was treated and in 16 patients, 2 or 3 regions were treated. Clinical follo w-up demonstrated significant improvement of angina pectoris (CCS-class at baseline: 3.1 +/- 0.2, 3 months after PMR: 1.8 +/- 0.7, 12 months after PMR : 1.5 +/- 0,9) (p < 0.001) and increased exercise capacity (exercise time o n standard bicycle ergometry at baseline: 383 +/- 151 s, 3 months after PMR : 494 +/- 140 s, 12 months after PMR: 480 +/- 151 s) (p < 0.05), but thalli um scintigraphy failed to show improved perfusion of the laser treated regi ons. Conclusions: PMR is a new safe and feasable therapeutic option in patients with refractory angina pectoris due to end-stage coronary artery disease. I nitial results show significant improvement of clinical symptoms and an inc reased exercise capacity but thallium scintigraphy failed to show improved perfusion after PMR.