In patients with severe
angina pectoris due to
coronary artery disease, who are not candidates for either percutaneous coronary angioplasty or
coronary artery bypass surgery,
transmyocardial laser revascularization (TMR) often leads to improvement of clinical symptoms and increased exercise capacity. One drawback of TMR is the need for surgical
thoracotomy in order to gain access to the epicardial surface of the heart. Therefore, a
catheter-based system has been developed, which allows creation of
laser channels into the myocardium from the left ventricular cavity.Between January 1997 and November 1999, this "percutaneous myocardial
laser-revascularization" (PMR) was performed in 85 patients at the Herzzentrum Leipzig. In 43 patients, only one region of the heart (anterior, lateral, inferior or septal) was treated with PMR; in 42 patients two or three regions were treated in one session. 12.3±4.3 (range 4-22) channels/region were created into the myocardium.Six months after PMR, the majority of patients reported significant improvement of clinical symptoms (CCS class at baseline: 3.3±0.4; after 6 months: 1.6±0.9) (p < 0.001) and an increased exercise capacity (baseline: 349±138 s; after 6 months: 470±193 s) (p < 0.05); however,
thallium scintigraphy failed to show increased perfusion in the PMR treated regions.PMR seems to be a safe and feasible new therapeutic option for patients with refractory
angina pectoris due to end-stage
coronary artery disease. The first results indicate improvement of clinical symptoms and increased exercise capacity; evidence of increased perfusion in the
laser-treated regions is still lacking.