Percutaneous transmyocardial laser revascularization: An overview

Transmyocardial revascularization (TMR) is a novel strategy designed to improve anginal symptoms and enhance myocardial perfusion by applying laser energy directly into the ischemic myocardium. Preliminary surgical experiences using TMR have indicated a significant reduction in angina severity, improved quality of life, and some evidence of improved myocardial perfusion in refractory coronary ischemic syndromes. Possible mechanisms to explain the clinical benefit include stimulated angiogenesis, local myocardial denervation, or both. The goal of catheter-based TMR is to create nontransmural endomyocardial channels smaller in size but comparable in tissue effect to the surgical TMR procedure. At present, most percutaneous TMR experiences seem very promising, although derived from nonrandomized registries with a relatively small number of patients. More rigorous assessments of objective and subjective endpoints derived from ongoing larger randomized clinical trials are needed to render definitive conclusion about the validity of this therapeutic strategy in patients with refractory coronary ischemic syndromes. Cathet, Cardiovasc, Intervent. 47:354-359, 1999, (C) 1999 Wiley-Liss, Inc.