Combined percutaneous biosense-guided laser myocardial revascularization and coronary intervention

Laser myocardial revascularization is a promising new treatment strategy fo r patients with severe ischemic heart disease who are not candidates for co nventional percutaneous or surgical revascularization, The open chest surgi cal approach to transmyocardial revascularization has been approved by the FDA for the treatment of angina in inoperable patients, but has had limited use as a stand-alone procedure. More recently, use of fiber-optic catheter s has made it possible to use a holmium:yttrium aluminum garnet laser to pe rform percutaneous catheter-based transmyocardial revascularization, To the extent that many patients have a combination of ischemic sources, some ame nable to conventional revascularization and some not, combination or hybrid approaches have been considered. We report herein two patients with class IV angina who underwent laser myocardial revascularization using the Biosen se system and complex percutaneous coronary intervention during the same pr ocedure. Areas amenable to conventional percutaneous coronary intervention (PCI) were so treated, and viable but ischemic areas were supplied by total ly occluded native vessels and bypass grafts underwent Biosense-guided lase r myocardial revascularization (LMR), As the results of more controlled and blinded studies of laser myocardial revascularization become available (if results continue to be promising) and a better understanding of the mechan ism of action of this treatment modality is achieved, LMR-PTCA hybrid will be performed in increasing frequency. However, even after establishing LMR efficacy, studies of LMR-PTCA hybrid should be conducted to determine the e fficacy of this approach. (C) 2001 Wiley-Liss, Inc.