Percutaneous myocardial laser-revascularization (PMR), a new therapy for patients with refractory angina pectoris

In patients with severe angina pectoris due to coronary artery disease, who are not candidates fur either percutaneous coronary angioplasty or coronar y artery bypass surgery, transmyocardial laser revascularization (TMR) ofte n leads to improvement of clinical symptoms and increased exercise capacity . One drawback of TMR is the need for surgical thoracotomy in order to gain access to the epicardial surface of the heart. Therefore, a catheter-based system has been develeped, which allows creation of laser channels into th e myocardium from the left ventricular cavity. Between January 1997 and November 1999, this "percutaneous myocardial laser -revascularization" (PMR) was performed in 85 patients at the Herzzentrum L eipzig. Tn 43 patients, only one region of the heart (anterior, lateral, in ferior or septal) was treated with PMR; in 42 patients two or three regions were treated ill one session. 12.3 +/- 4.3 (range 4-22) channels/region we re created into the myocardium. Six months after PMR, the majority of patients reported significant improve ment of clinical symptoms (CCS class at baseline: 3.3 +/- 0.4; after 6 mont hs: 1.6 +/- 0.9) (p < 0.001) and an increased exercise capacity (baseline: 349 +/- 138 s; after 6 months: 470 +/- 193 s) (p < 0.05); however, thallium scintigraphy failed to show increased perfusion in the PMR treated regions . PMR seems to be a safe and feasible new therapeutic option fur patients wit h refractory angina pectoris due to end-stage coronary artery disease. The first results indicate improvement of clinical symptoms and increased exerc ise capacity; evidence of increased pel-fusion in the laser-treated regions is still lacking.