title: Catheter-based autologous bone marrow myocardial injection in no-option patients with advanced coronary artery disease: a feasibility study.
abstract: OBJECTIVE
  We conducted a pilot study to evaluate the feasibility of transendocardial delivery of autologous bone marrow (ABM) strategy in patients with severe symptomatic chronic myocardial ischemia not amenable to conventional revascularization.
  
  
  BACKGROUND
  Transendocardial injection of ABM cells appears to enhance perfusion of ischemic porcine myocardium.
  
  
  METHODS
  Ten patients underwent transendocardial injection of freshly aspirated and filtered unfractionated ABM using left ventricular electromechanical guidance. Twelve injections of 0.2 ml each were successfully delivered into ischemic noninfarcted myocardium pre-identified by single-photon emission computed tomography perfusion imaging.
  
  
  RESULTS
  Autologous bone marrow injection was successful in all patients and was associated with no serious adverse effects; in particular, there was no arrhythmia, evidence of infection, myocardial inflammation, or increased scar formation. Two patients were readmitted for recurrent chest pain. At three months, Canadian Cardiovascular Society angina score significantly improved (3.1 +/- 0.3 vs. 2.0 +/- 0.94, p = 0.001), as well as stress-induced ischemia occurring within the injected territories (2.1 +/- 0.8 vs. 1.6 +/- 0.8, p < 0.001). Treadmill exercise duration, available in nine patients, increased, but the change was not significant (391 +/- 155 vs. 485 +/- 198, p = 0.11).
  
  
  CONCLUSIONS
  This study provides preliminary clinical data indicating feasibility of catheter-based transendocardial delivery of ABM to ischemic myocardium.
authors.affiliation: Cardiovascular Research Institute, MedStar Research Institute, Washington Hospital Center, 110 Irving Street NW, 4B-1, Washington, DC 20010, USA. sfuchsel2002@yahoo.com
authors.forename: Shmuel
authors.initials: S
authors.lastname: Fuchs
authors.forename: Lowell F
authors.initials: LF
authors.lastname: Satler
authors.forename: Ran
authors.initials: R
authors.lastname: Kornowski
authors.forename: Petros
authors.initials: P
authors.lastname: Okubagzi
authors.forename: Giora
authors.initials: G
authors.lastname: Weisz
authors.forename: Richard
authors.initials: R
authors.lastname: Baffour
authors.forename: Ron
authors.initials: R
authors.lastname: Waksman
authors.forename: Neil J
authors.initials: NJ
authors.lastname: Weissman
authors.forename: Manuel
authors.initials: M
authors.lastname: Cerqueira
authors.forename: Martin B
authors.initials: MB
authors.lastname: Leon
authors.forename: Stephen E
authors.initials: SE
authors.lastname: Epstein
mesh_terms: D016026:Bone Marrow Transplantation; D002404:Catheterization; D003326:Coronary Circulation; D003327:Coronary Disease / Q000000981:diagnostic imaging / Q000628:therapy*; D005240:Feasibility Studies; D005260:Female; D006321:Heart / Q000000981:diagnostic imaging; D006801:Humans; D007267:Injections; D008297:Male; D008875:Middle Aged; D009206:Myocardium; D010865:Pilot Projects; D015899:Tomography, Emission-Computed, Single-Photon; D014182:Transplantation, Autologous