Direct intramyocardial percutaneous delivery of autologous bone marrow in patients with refractory myocardial angina.
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.
Briguori
Carlo
C
Vita-Salute University School of Medicine, San Raffaele Hospital, Milan, Italy.
Reimers
Bernhard
B
Sarais
Cristiano
C
Napodano
Massimo
M
Pascotto
Pietro
P
Azzarello
Giuseppe
G
Bregni
Marco
M
Porcellini
Adolfo
A
Vinante
Orazio
O
Zanco
Pierluigi
P
Peschle
Cesare
C
Condorelli
Gianluigi
G
Colombo
Antonio
A
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