IAGS 200_Mar01_Shawl.qxd

نویسنده

  • Fayaz Shawl
چکیده

revascularization, there is a growing population of patients who are not candidates for either coronary artery bypass grafting (CABG) or conventional percutaneous coronary intervention (PCI). This population is heterogeneous and includes patients with diffuse coronary disease, comorbid conditions or multiple previous bypass operations resulting in no remaining suitable conduits. The majority of such patients present with severe angina despite maximum medical therapy. Additional management by revascularization is difficult because of diffuse disease not approachable by either CABG or PCI. The goal of therapy in such patients is to improve their quality of life and, if possible, to prolong it. The purpose of this article is to review the current status of novel techniques that are being developed to deal with this frustrating group of patients. Specifically, transmyocardial revascularization (TMR) is examined. Transmyocardial revascularization. T r a n s m y o c a rdial revascularization is a therapeutic strategy designed to enhance myocardial perfusion by creating channels with laser energy directly in the ischemic myocardiu m . – 5 Clinical studies have reported angina relief in many of these patients, making this technique potentially promising. – 8 The mechanism of improvement is not entirely clear, but may be a combination of new vessel growth (angiogenesis), direct perfusion, or denervat i o n . , 1 0 Also, a substantial placebo effect is possible. The surgical approach to TMR, however, has been limited by high perioperative mortality. – 8 The adaptation of the holmium: yttrium-aluminum-garnet (YAG) laser, which can create channels in the presence of the myocardial blood pool, makes a transcatheter approach possible. 1 – 1 7

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تاریخ انتشار 2006