title: Direct intramyocardial percutaneous delivery of autologous bone marrow in patients with refractory myocardial angina.
abstract: BACKGROUND
  Intramyocardial injection of autologous bone marrow (ABM) may induce angiogenesis. We tested the safety and feasibility of catheter-based direct percutaneous intramyocardial delivery of ABM in patients with refractory angina pectoris.
  
  
  METHODS
  Ten patients (9 men, 67 +/- 8 years) with refractory angina (Canadian Cardiovascular Society class III-IV) and documented myocardial ischemia were enrolled. After left ventricular electromechanical mapping, freshly aspirated and filtered ABM was percutaneously injected into target myocardial ischemic areas. Clinical symptoms (as assessed according to the Canadian Cardiovascular Society class), quality of life, and myocardial perfusion were evaluated before the procedure and through the follow-up.
  
  
  RESULTS
  In all patients, ABM was successfully injected into the target regions. No periprocedural complications occurred. At 12 months, no major cardiac events (death, acute myocardial infarction, stroke, and malignant ventricular arrhythmias) occurred. Severity of angina improved of > or = 2 classes in 3 patients. Quality of life showed a significant improvement in all patients. Myocardial perfusion in the target regions improved in 4 of 8 patients.
  
  
  CONCLUSIONS
  Direct percutaneous intramyocardial delivery of ABM appears feasible and safe. Further evaluation is warranted to test its clinical efficacy.
authors.affiliation: Vita-Salute University School of Medicine, San Raffaele Hospital, Milan, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Briguori
authors.forename: Bernhard
authors.initials: B
authors.lastname: Reimers
authors.forename: Cristiano
authors.initials: C
authors.lastname: Sarais
authors.forename: Massimo
authors.initials: M
authors.lastname: Napodano
authors.forename: Pietro
authors.initials: P
authors.lastname: Pascotto
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Azzarello
authors.forename: Marco
authors.initials: M
authors.lastname: Bregni
authors.forename: Adolfo
authors.initials: A
authors.lastname: Porcellini
authors.forename: Orazio
authors.initials: O
authors.lastname: Vinante
authors.forename: Pierluigi
authors.initials: P
authors.lastname: Zanco
authors.forename: Cesare
authors.initials: C
authors.lastname: Peschle
authors.forename: Gianluigi
authors.initials: G
authors.lastname: Condorelli
authors.forename: Antonio
authors.initials: A
authors.lastname: Colombo
mesh_terms: D000368:Aged; D000787:Angina Pectoris / Q000503:physiopathology / Q000601:surgery*; D001854:Bone Marrow Cells; D016026:Bone Marrow Transplantation; D003114:Colony-Forming Units Assay; D017023:Coronary Angiography; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D016130:Immunophenotyping; D015552:Injections, Intralesional; D008297:Male; D008875:Middle Aged; D018919:Neovascularization, Physiologic; D010865:Pilot Projects; D011788:Quality of Life; D015899:Tomography, Emission-Computed, Single-Photon; D014182:Transplantation, Autologous; D016896:Treatment Outcome