Clinical and histological evaluation of laser myocardial revascularization.

Studies exploring methods to revascularize the ischemic myocardium through increasing the collateral circulation were conducted by many investigators before the advent of myocardial revascularization by aortocoronary bypass grafting. Present alternatives, including surgical intervention, balloon angioplasty, thrombolytic therapy, and medical management, are the treatment of choice for the majority of patients. There are, however, a number of patients who do not respond to conventional management strategies. A clinical protocol was designed to assess the efficacy of transmural revascularization by creating CO2 laser channels in the ischemic areas of the left ventricle. Channels were made from the epicardial surface of the heart, through the ventricle, to the endocardium. Patients entered in the study were candidates for bypass grafting, but because of the pathology of the coronary artery system, bypass grafting alone would have resulted in incomplete revascularization. Postoperative thallium stress tests and left ventriculography indicate that channels have remained patent and that they perfuse the myocardium. Myocardial revascularization by laser channels may offer a viable adjunct in the treatment of ischemic heart disease.