Transmyocardial laser revascularization versus medical therapy for refractory angina

Briones, Eduardo; Lacalle-Remigio, Juan R.; Marı́n, Irma

doi:10.1590/s1516-31802011000300013

Cited by 11 publications

(16 citation statements)

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“…23 There are numerous treatment options aiming at alleviating myocardial ischemia using angiogenic therapeutic approaches (by the so-called myocardial laser revascularization, 24 external shock wave therapy, 25 and myocardial stem cell application 26 ), diastolic coronary pressure augmentation by external counterpulsation, 27 coronary arteriogenesis with induction of large collateral artery remodeling, 28 coronary sinus venous backpressure augmentation, 29,30 and ischemic preconditioning. 31,32 The latter represents the default therapy applied by any primary or secondary prevention program because physical exercise with myocardial ischemia is its cornerstone.…”

Section: Discussionmentioning

confidence: 99%

Effect of Permanent Right Internal Mammary Artery Closure on Coronary Collateral Function and Myocardial Ischemia

Stoller

Seiler

2017

Circ: Cardiovascular Interventions

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Background—The objective of this study is to test the effect of permanent right internal mammary artery device closure on coronary collateral function and myocardial ischemia.Methods and Results—This was a prospective, open-label clinical trial in 50 patients with coronary artery disease. The primary study end point was coronary collateral flow index as obtained during a 1-minute proximal right coronary artery (RCA) and left coronary artery balloon occlusion at baseline before and at follow-up examination 6 weeks after distal right internal mammary artery device closure. Collateral flow index is the ratio between simultaneously recorded mean coronary occlusive pressure divided by mean aortic pressure, both subtracted by central venous pressure. Secondary study end points were fractional flow reserve during vessel patency, the quantitative intracoronary ECG ST-segment elevation, and angina pectoris during the same 1-minute coronary occlusion. Collateral flow index in the untreated RCA and left coronary artery changed from 0.071±0.082 at baseline to 0.132±0.117 (P<0.0001) at follow-up examination and from 0.106±0.092 to 0.081±0.079 (P=0.29), respectively. RCA fractional flow reserve increased significantly (P=0.0029) from baseline to follow-up examination, despite deferral of coronary intervention in all patients. There was a decrease in intracoronary ECG ST-elevation during RCA occlusion from baseline to follow-up examination (P=0.0015); it did not change in the left coronary artery. Angina pectoris during RCA occlusion tended to occur in fewer patients at follow-up versus baseline examination (P=0.06).Conclusions—Permanent right internal mammary artery device closure seems to augment extracardiac ipsilateral coronary supply to the effect of reducing ischemia in the dependent myocardial region.Clinical Trial Registration—URL: http://www.clinicaltrials.gov. Unique identifier: NCT02475408.

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Section: Discussionmentioning

confidence: 99%

Effect of Permanent Right Internal Mammary Artery Closure on Coronary Collateral Function and Myocardial Ischemia

Stoller

Seiler

2017

Circ: Cardiovascular Interventions

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“…A number of studies showed that transmyocardial [5] and percutaneous myocardial laser revascularization [6, 7], spinal cord stimulation [8] and stem cell therapy [9–11] may reduce angina symptoms and improve exercise capacity, myocardial perfusion and function. Nevertheless, these treatment modalities are invasive, quite expensive or still at a preclinical stage.…”

Section: Introductionmentioning

confidence: 99%

Cardiac shock-wave therapy in the treatment of coronary artery disease: systematic review and meta-analysis

Burneikaitė

Shkolnik

Čelutkienė

et al. 2017

Cardiovasc Ultrasound

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AimTo systematically review currently available cardiac shock-wave therapy (CSWT) studies in humans and perform meta-analysis regarding anti-anginal efficacy of CSWT.MethodsThe Cochrane Controlled Trials Register, Medline, Medscape, Research Gate, Science Direct, and Web of Science databases were explored. In total 39 studies evaluating the efficacy of CSWT in patients with stable angina were identified including single arm, non- and randomized trials. Information on study design, subject’s characteristics, clinical data and endpoints were obtained. Assessment of publication risk of bias was performed and heterogeneity across the studies was calculated by using random effects model.ResultsTotally, 1189 patients were included in 39 reviewed studies, with 1006 patients treated with CSWT. The largest patient sample of single arm study consisted of 111 patients. All selected studies demonstrated significant improvement in subjective measures of angina symptoms and/or quality of life, in the majority of studies left ventricular function and myocardial perfusion improved. In 12 controlled studies with 483 patients included (183 controls) angina class, Seattle Angina Questionnaire (SAQ) score, nitrates consumption were significantly improved after the treatment.In 593 participants across 22 studies the exercise capacity was significantly improved after CSWT, as compared with the baseline values (in meta-analysis standardized mean difference SMD = −0.74; 95% CI, −0.97 to −0.5; p < 0.001).ConclusionsSystematic review of CSWT studies in stable coronary artery disease (CAD) demonstrated consistent improvement of clinical variables. Meta-analysis showed a moderate improvement of exercise capacity.Overall, CSWT is a promising non-invasive option for patients with end-stage CAD, but evidence is limited to small sample single-center studies. Multi-center adequately powered randomised double blind studies are warranted.

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“…Numerous authors [8,9,10,11,12] confirm that regional BMC is competent in restoring ischemic myocardium microvasculature and, likely, fix myocardial defects by functioning cardiac myocytes, which leads to a decrease in angina class and partial recovery of cardiac contractility. In this study, we investigated the possibility of BMC to differentiate into cardiomyocytes, with an emphasis on neovascularization in the ischemic myocardium and formation of de novo vessels, without cambial elements of pre-existing vasculature vasculogenesis and prospects for a longterm period.…”

Section: Discussionmentioning

confidence: 99%

Bone marrow mononuclear cell implantation in myocardial laser channels in the ischemic heart disease surgery. Long-term results

Chernyavskiy

Фомичев

Минин

et al. 2017

AIP Conference Proceedings

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Abstract. Background: The problem of incomplete myocardial revascularization for diffuse and distal lesions of the myocardium is still relevant. We assessed the clinical and instrumental long-term results of autologous bone marrow cell (BMC) implantation in laser channels in ischemic heart disease with diffuse and distal coronary disease. 35 coronary heart disease (CHD) patients with diffuse and distal coronary disease during coronary artery bypass grafting (CABG) underwent BMC implantation in laser channels. The control group consisted of 29 patients. All patients in this group underwent only CABG. Clinical and instrumental assessment of the method's effect was carried out at two weeks, six months, and six years after surgery. Indirect revascularization showed more significant decreasing of the functional class (FC) New York Heart Association (NYHA), myocardial perfusion and contractility improvement. Autologous BMC implantation in laser channels is an effective method of CHD surgical treatment if it is impossible to perform direct myocardial revascularization. The indirect revascularization effect is formed in the first six months after surgery and remains at the same level for six years.

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Transmyocardial laser revascularization versus medical therapy for refractory angina

Abstract: The independent commentary was written by José Henrique Andrade Vila and José Pedro da Silva.

Cited by 11 publications

References 1 publication

Effect of Permanent Right Internal Mammary Artery Closure on Coronary Collateral Function and Myocardial Ischemia

Effect of Permanent Right Internal Mammary Artery Closure on Coronary Collateral Function and Myocardial Ischemia

Cardiac shock-wave therapy in the treatment of coronary artery disease: systematic review and meta-analysis

Bone marrow mononuclear cell implantation in myocardial laser channels in the ischemic heart disease surgery. Long-term results

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