[Percutaneous myocardial laser revascularization. A new therapy technique for patients with coronary disease and severe angina pectoris without conventional therapy options].
OBJECTIVE
In patients with intractable angina because of end-stage coronary artery disease, transmyocardial laser revascularization (TMR) leads to improvement of angina pectoris and increased exercise capacity. However, surgical thoracotomy is required for TMR with considerable morbidity and mortality. Therefore, a catheter-based laser system has been developed which allows to create laser channels into the myocardium from the left ventricular cavity.


METHODS
46 patients (38 m, 8 f) with refractory angina pectoris due to severe coronary artery disease were treated with "percutaneous myocardial laser revascularisation" (PMR). Clinical parameters (severity of angina pectoris, use of additional nitroglycerin) and results of non-invasive tests (exercise-ECG, echocardiography, thallium-scintigraphy) were analysed at baseline and 3, 6 and 12 months after PMR.


RESULTS
The PMR procedure was successfully completed in all patients. In 30 patients, one region (anterior, lateral, inferior) of the left ventricle was treated and in 16 patients, 2 or 3 regions were treated. Clinical follow-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 on 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 thallium scintigraphy failed to show improved perfusion of the laser treated regions.


CONCLUSIONS
PMR is a new safe and feasible therapeutic option in patients with refractory angina pectoris due to end-stage coronary artery disease. Initial results show significant improvement of clinical symptoms and an increased exercise capacity but thallium scintigraphy failed to show improved perfusion after PMR.
Lauer
B
B
Klinik für Innere Medizin/Kardiologie, Universität Leipzig, Herzzentrum GmbH. laub@server3.medizin.uni-leipzig.de
Stahl
F
F
Junghans
U
U
Kluge
R
R
Schuler
G
G
D000368:Aged; D000369:Aged, 80 and over; D000787:Angina Pectoris / Q000209:etiology / Q000601:surgery*; D006328:Cardiac Catheterization; D003327:Coronary Disease / Q000150:complications / Q000601:surgery*; D005080:Exercise Test; D005260:Female; D006321:Heart / Q000000981:diagnostic imaging; D006801:Humans; D053685:Laser Therapy / Q000295:instrumentation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D015425:Myocardial Reperfusion; D009204:Myocardial Revascularization / Q000295:instrumentation / Q000379:methods*; D011877:Radionuclide Imaging; D012720:Severity of Illness Index; D013997:Time Factors