Laser percutaneous myocardial revascularization

The increasing numbers of patients with refractory angina and coronary disease unamenable to traditional methods of revascularization has led to the emergence of new therapeutic approaches. Current data indicate that laser transmyocardial revascularization (TMR), typically requiring open thoracotomy, may provide these patients with improvements in angina class and myocardial perfusion. Recently, a percutaneous, catheter-based myocardial revascularization procedure has been developed with laser technology that permits the creation of channels from the endocardial surface of the left ventricle. This procedure has been evaluated in a pilot study of 30 patients with Canadian class III–IV angina and coronary artery disease unamenable to traditional methods of revascularization. The results demonstrated that the clinical application of percutaneous myocardial revascularization (PMR) is safe, and preliminary data indicate that the majority of patients experienced significant improvement in anginal symptoms. An ongoing multicenter randomized study is comparing PMR with conventional medical therapy in patients with severe, refractory angina, evidence of reversible ischemia, and contraindications to angioplasty or bypass surgery.