Catheter-based percutaneous myocardial laser revascularization in patients with end-stage coronary artery disease
OBJECTIVES This study evaluates the feasibility and safety of a catheter-based laser system for percutaneous myocardial revascularization and analyses the first clinical acute and long-term results in patients with end-stage coronary artery disease (CAD) and severe angina pectoris. BACKGROUND In pat...
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| Veröffentlicht in: | Journal of the American College of Cardiology 1999-11, Vol.34 (6), p.1663-1670 |
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| creator | Lauer, Bernward Junghans, Ulrike Stahl, Fabian Kluge, Regina Oesterle, Stephen N. Schuler, Gerhard |
| description | OBJECTIVES
This study evaluates the feasibility and safety of a catheter-based laser system for percutaneous myocardial revascularization and analyses the first clinical acute and long-term results in patients with end-stage coronary artery disease (CAD) and severe angina pectoris.
BACKGROUND
In patients with CAD and intractable angina who are not candidates for either coronary artery bypass grafting (CABG) or percutaneous transluminal coronary angioplasty (PTCA), transmyocardial laser revascularization (TMR) has been developed as a new treatment that results in reduced angina pectoris and increased exercise capacity. However, surgical thoracotomy is required for TMR with considerable morbidity and mortality.
METHODS
A catheter-based system has been developed that allows creation of laser channels in the myocardium from within the left ventricular cavity. Laser energy generated by a Holmium: YAG (Cardiogenesis Corporation, Sunnyvale, California) laser was transmitted to the myocardium via a flexible optical fiber capped by an optic lens. The optical fiber was maneuvered to the target area under biplane fluoroscopy through a coaxial catheter system permitting movement in three dimensions.
RESULTS
Thirty-four patients with severe CAD not amenable to either CABG or PTCA and refractory angina pectoris (Canadian Cardiologic Society [CCS] Angina Scale Class III–IV) were included in the study. Ischemic regions were identified by coronary angiography and confirmed by thallium scintigraphy. The percutaneous myocardial revascularization (PMR) procedure was successfully completed in all patients. In 29 patients, one vascular territory of the left ventricle and in 5 patients, two vascular territories were treated. Eight to fifteen channels were created in each ischemic region. Major periprocedural complications were limited to an episode of arterial bleeding requiring surgical repair. There was one death early after PMR, due to a myocardial infarction (MI) in a nontreated region. Clinical follow-up at 6 months (17 patients) demonstrated significant improvement of angina pectoris (CCS class before PMR: 3.0 ± 0.0, six months after PMR: 1.3 ± 0.8, p < 0.0001) and increased exercise capacity (exercise time on standard bicycle ergometry before PMR: 384 ± 141 s, six months after PMR: 514 ± 158 s, p < 0.05), but thallium scintigraphy failed to show improved perfusion of the laser treated regions.
CONCLUSIONS
Percutaneous myocardial revascularization is a new safe and feasibl |
| doi_str_mv | 10.1016/S0735-1097(99)00419-2 |
| format | Article |
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This study evaluates the feasibility and safety of a catheter-based laser system for percutaneous myocardial revascularization and analyses the first clinical acute and long-term results in patients with end-stage coronary artery disease (CAD) and severe angina pectoris.
BACKGROUND
In patients with CAD and intractable angina who are not candidates for either coronary artery bypass grafting (CABG) or percutaneous transluminal coronary angioplasty (PTCA), transmyocardial laser revascularization (TMR) has been developed as a new treatment that results in reduced angina pectoris and increased exercise capacity. However, surgical thoracotomy is required for TMR with considerable morbidity and mortality.
METHODS
A catheter-based system has been developed that allows creation of laser channels in the myocardium from within the left ventricular cavity. Laser energy generated by a Holmium: YAG (Cardiogenesis Corporation, Sunnyvale, California) laser was transmitted to the myocardium via a flexible optical fiber capped by an optic lens. The optical fiber was maneuvered to the target area under biplane fluoroscopy through a coaxial catheter system permitting movement in three dimensions.
RESULTS
Thirty-four patients with severe CAD not amenable to either CABG or PTCA and refractory angina pectoris (Canadian Cardiologic Society [CCS] Angina Scale Class III–IV) were included in the study. Ischemic regions were identified by coronary angiography and confirmed by thallium scintigraphy. The percutaneous myocardial revascularization (PMR) procedure was successfully completed in all patients. In 29 patients, one vascular territory of the left ventricle and in 5 patients, two vascular territories were treated. Eight to fifteen channels were created in each ischemic region. Major periprocedural complications were limited to an episode of arterial bleeding requiring surgical repair. There was one death early after PMR, due to a myocardial infarction (MI) in a nontreated region. Clinical follow-up at 6 months (17 patients) demonstrated significant improvement of angina pectoris (CCS class before PMR: 3.0 ± 0.0, six months after PMR: 1.3 ± 0.8, p < 0.0001) and increased exercise capacity (exercise time on standard bicycle ergometry before PMR: 384 ± 141 s, six months after PMR: 514 ± 158 s, p < 0.05), but thallium scintigraphy failed to show improved perfusion of the laser treated regions.
CONCLUSIONS
Percutaneous myocardial revascularization is a new safe and feasible therapeutic option in patients with CAD and severe angina pectoris not amenable to either CABG or PTCA. Initial results show immediate and significant improvement of symptoms and exercise capacity but evidence of improved myocardial perfusion is still lacking.</description><identifier>ISSN: 0735-1097</identifier><identifier>EISSN: 1558-3597</identifier><identifier>DOI: 10.1016/S0735-1097(99)00419-2</identifier><identifier>PMID: 10577553</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Aged ; Aged, 80 and over ; Angina Pectoris - surgery ; Cardiac Catheterization ; Coronary Angiography ; Coronary Disease - surgery ; Feasibility Studies ; Female ; Humans ; Laser Therapy - methods ; Male ; Middle Aged ; Myocardial Revascularization - methods ; Pilot Projects ; Treatment Outcome</subject><ispartof>Journal of the American College of Cardiology, 1999-11, Vol.34 (6), p.1663-1670</ispartof><rights>1999 American College of Cardiology</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c396t-d1814bd7bf874717be0e241d7c8eef780153af52ebf981a951df8ac84e2956eb3</citedby><cites>FETCH-LOGICAL-c396t-d1814bd7bf874717be0e241d7c8eef780153af52ebf981a951df8ac84e2956eb3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/S0735-1097(99)00419-2$$EHTML$$P50$$Gelsevier$$Hfree_for_read</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/10577553$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Lauer, Bernward</creatorcontrib><creatorcontrib>Junghans, Ulrike</creatorcontrib><creatorcontrib>Stahl, Fabian</creatorcontrib><creatorcontrib>Kluge, Regina</creatorcontrib><creatorcontrib>Oesterle, Stephen N.</creatorcontrib><creatorcontrib>Schuler, Gerhard</creatorcontrib><title>Catheter-based percutaneous myocardial laser revascularization in patients with end-stage coronary artery disease</title><title>Journal of the American College of Cardiology</title><addtitle>J Am Coll Cardiol</addtitle><description>OBJECTIVES
This study evaluates the feasibility and safety of a catheter-based laser system for percutaneous myocardial revascularization and analyses the first clinical acute and long-term results in patients with end-stage coronary artery disease (CAD) and severe angina pectoris.
BACKGROUND
In patients with CAD and intractable angina who are not candidates for either coronary artery bypass grafting (CABG) or percutaneous transluminal coronary angioplasty (PTCA), transmyocardial laser revascularization (TMR) has been developed as a new treatment that results in reduced angina pectoris and increased exercise capacity. However, surgical thoracotomy is required for TMR with considerable morbidity and mortality.
METHODS
A catheter-based system has been developed that allows creation of laser channels in the myocardium from within the left ventricular cavity. Laser energy generated by a Holmium: YAG (Cardiogenesis Corporation, Sunnyvale, California) laser was transmitted to the myocardium via a flexible optical fiber capped by an optic lens. The optical fiber was maneuvered to the target area under biplane fluoroscopy through a coaxial catheter system permitting movement in three dimensions.
RESULTS
Thirty-four patients with severe CAD not amenable to either CABG or PTCA and refractory angina pectoris (Canadian Cardiologic Society [CCS] Angina Scale Class III–IV) were included in the study. Ischemic regions were identified by coronary angiography and confirmed by thallium scintigraphy. The percutaneous myocardial revascularization (PMR) procedure was successfully completed in all patients. In 29 patients, one vascular territory of the left ventricle and in 5 patients, two vascular territories were treated. Eight to fifteen channels were created in each ischemic region. Major periprocedural complications were limited to an episode of arterial bleeding requiring surgical repair. There was one death early after PMR, due to a myocardial infarction (MI) in a nontreated region. Clinical follow-up at 6 months (17 patients) demonstrated significant improvement of angina pectoris (CCS class before PMR: 3.0 ± 0.0, six months after PMR: 1.3 ± 0.8, p < 0.0001) and increased exercise capacity (exercise time on standard bicycle ergometry before PMR: 384 ± 141 s, six months after PMR: 514 ± 158 s, p < 0.05), but thallium scintigraphy failed to show improved perfusion of the laser treated regions.
CONCLUSIONS
Percutaneous myocardial revascularization is a new safe and feasible therapeutic option in patients with CAD and severe angina pectoris not amenable to either CABG or PTCA. Initial results show immediate and significant improvement of symptoms and exercise capacity but evidence of improved myocardial perfusion is still lacking.</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Angina Pectoris - surgery</subject><subject>Cardiac Catheterization</subject><subject>Coronary Angiography</subject><subject>Coronary Disease - surgery</subject><subject>Feasibility Studies</subject><subject>Female</subject><subject>Humans</subject><subject>Laser Therapy - methods</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Myocardial Revascularization - methods</subject><subject>Pilot Projects</subject><subject>Treatment Outcome</subject><issn>0735-1097</issn><issn>1558-3597</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>1999</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkE1LxDAQhoMouq7-BCUn0UM1aZsmOYksfoHgQT2HNJm6kW67JunK-uvNWhFvXmYG5p13Zh6Ejig5p4RWF0-EFyyjRPJTKc8IKanM8i00oYyJrGCSb6PJr2QP7YfwRgipBJW7aI8SxjljxQS9z3ScQwSf1TqAxUvwZoi6g34IeLHujfbW6Ra3qeuxh5UOZmi1d586ur7DrsPLVEEXA_5wcY6hs1mI-hWw6X3fab_G2if_NbYuQHI5QDuNbgMc_uQperm5fp7dZQ-Pt_ezq4fMFLKKmaWClrXldSN4ySmvgUBeUsuNAGi4IJQVumE51I0UVEtGbSO0ESXkklVQF1N0Mvouff8-QIhq4YKBth2fU5UsSMFSnCI2Co3vQ_DQqKV3i3S4okRtWKtv1moDUkmpvlmrPM0d_ywY6gXYP1Mj3CS4HAWQ3lw58CqYRMqAdR5MVLZ3_6z4AjyCkdI</recordid><startdate>19991115</startdate><enddate>19991115</enddate><creator>Lauer, Bernward</creator><creator>Junghans, Ulrike</creator><creator>Stahl, Fabian</creator><creator>Kluge, Regina</creator><creator>Oesterle, Stephen N.</creator><creator>Schuler, Gerhard</creator><general>Elsevier Inc</general><scope>6I.</scope><scope>AAFTH</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>19991115</creationdate><title>Catheter-based percutaneous myocardial laser revascularization in patients with end-stage coronary artery disease</title><author>Lauer, Bernward ; Junghans, Ulrike ; Stahl, Fabian ; Kluge, Regina ; Oesterle, Stephen N. ; Schuler, Gerhard</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c396t-d1814bd7bf874717be0e241d7c8eef780153af52ebf981a951df8ac84e2956eb3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>1999</creationdate><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Angina Pectoris - surgery</topic><topic>Cardiac Catheterization</topic><topic>Coronary Angiography</topic><topic>Coronary Disease - surgery</topic><topic>Feasibility Studies</topic><topic>Female</topic><topic>Humans</topic><topic>Laser Therapy - methods</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Myocardial Revascularization - methods</topic><topic>Pilot Projects</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Lauer, Bernward</creatorcontrib><creatorcontrib>Junghans, Ulrike</creatorcontrib><creatorcontrib>Stahl, Fabian</creatorcontrib><creatorcontrib>Kluge, Regina</creatorcontrib><creatorcontrib>Oesterle, Stephen N.</creatorcontrib><creatorcontrib>Schuler, Gerhard</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of the American College of Cardiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Lauer, Bernward</au><au>Junghans, Ulrike</au><au>Stahl, Fabian</au><au>Kluge, Regina</au><au>Oesterle, Stephen N.</au><au>Schuler, Gerhard</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Catheter-based percutaneous myocardial laser revascularization in patients with end-stage coronary artery disease</atitle><jtitle>Journal of the American College of Cardiology</jtitle><addtitle>J Am Coll Cardiol</addtitle><date>1999-11-15</date><risdate>1999</risdate><volume>34</volume><issue>6</issue><spage>1663</spage><epage>1670</epage><pages>1663-1670</pages><issn>0735-1097</issn><eissn>1558-3597</eissn><abstract>OBJECTIVES
This study evaluates the feasibility and safety of a catheter-based laser system for percutaneous myocardial revascularization and analyses the first clinical acute and long-term results in patients with end-stage coronary artery disease (CAD) and severe angina pectoris.
BACKGROUND
In patients with CAD and intractable angina who are not candidates for either coronary artery bypass grafting (CABG) or percutaneous transluminal coronary angioplasty (PTCA), transmyocardial laser revascularization (TMR) has been developed as a new treatment that results in reduced angina pectoris and increased exercise capacity. However, surgical thoracotomy is required for TMR with considerable morbidity and mortality.
METHODS
A catheter-based system has been developed that allows creation of laser channels in the myocardium from within the left ventricular cavity. Laser energy generated by a Holmium: YAG (Cardiogenesis Corporation, Sunnyvale, California) laser was transmitted to the myocardium via a flexible optical fiber capped by an optic lens. The optical fiber was maneuvered to the target area under biplane fluoroscopy through a coaxial catheter system permitting movement in three dimensions.
RESULTS
Thirty-four patients with severe CAD not amenable to either CABG or PTCA and refractory angina pectoris (Canadian Cardiologic Society [CCS] Angina Scale Class III–IV) were included in the study. Ischemic regions were identified by coronary angiography and confirmed by thallium scintigraphy. The percutaneous myocardial revascularization (PMR) procedure was successfully completed in all patients. In 29 patients, one vascular territory of the left ventricle and in 5 patients, two vascular territories were treated. Eight to fifteen channels were created in each ischemic region. Major periprocedural complications were limited to an episode of arterial bleeding requiring surgical repair. There was one death early after PMR, due to a myocardial infarction (MI) in a nontreated region. Clinical follow-up at 6 months (17 patients) demonstrated significant improvement of angina pectoris (CCS class before PMR: 3.0 ± 0.0, six months after PMR: 1.3 ± 0.8, p < 0.0001) and increased exercise capacity (exercise time on standard bicycle ergometry before PMR: 384 ± 141 s, six months after PMR: 514 ± 158 s, p < 0.05), but thallium scintigraphy failed to show improved perfusion of the laser treated regions.
CONCLUSIONS
Percutaneous myocardial revascularization is a new safe and feasible therapeutic option in patients with CAD and severe angina pectoris not amenable to either CABG or PTCA. Initial results show immediate and significant improvement of symptoms and exercise capacity but evidence of improved myocardial perfusion is still lacking.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>10577553</pmid><doi>10.1016/S0735-1097(99)00419-2</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
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| source | MEDLINE; Elsevier ScienceDirect Journals Complete; Alma/SFX Local Collection; EZB Electronic Journals Library |
| subjects | Aged Aged, 80 and over Angina Pectoris - surgery Cardiac Catheterization Coronary Angiography Coronary Disease - surgery Feasibility Studies Female Humans Laser Therapy - methods Male Middle Aged Myocardial Revascularization - methods Pilot Projects Treatment Outcome |
| title | Catheter-based percutaneous myocardial laser revascularization in patients with end-stage coronary artery disease |
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