Sundt T M, Rogers J G
Division of Cardiothoracic Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, MO 63110, USA.
Curr Opin Cardiol. 1997 Sep;12(5):441-6.
Interest in transmyocardial laser revascularization for the treatment of otherwise inoperable coronary artery disease has increased rather dramatically in recent years. The results of several industrially sponsored clinical series have been reported recently, all with significant improvement in angina pectoris that appears both rapid and sustained. In most instances, an associated improvement in exercise tolerance has been reported. Improvement in regional myocardial perfusion has been proclaimed, although it is less consistent and less complete than symptom relief. The mechanisms whereby this clinical effect is achieved remain unknown. Histologic analysis of autopsy material has yielded somewhat conflicting results regarding the persistent patency of laser-created channels. The results of laboratory investigations of this therapy have been equally inconsistent. Despite our ignorance regarding the mechanism of angina relief, clinical experience continues to grow. In addition to the CO2 laser energy source used in early studies, trials of alternative devices using holmium:yttrium-aluminum-garnet and eximer lasers are underway. The latter two employ fiberoptic technology and are currently under development for endovascular approaches.
近年来，经心肌激光血运重建术治疗其他方法无法手术的冠状动脉疾病受到的关注急剧增加。最近有几个由产业界赞助的临床系列报道了其结果，所有报道均显示心绞痛有显著改善，且这种改善出现迅速且持续。在大多数情况下，还报道了运动耐量的相关改善。尽管局部心肌灌注的改善不如症状缓解那么一致和完全，但也有人宣称其有所改善。实现这种临床效果的机制仍然未知。尸检材料的组织学分析对于激光形成的通道的持续通畅性得出了有些相互矛盾的结果。该疗法的实验室研究结果同样不一致。尽管我们对心绞痛缓解的机制尚不清楚，但临床经验仍在不断积累。除了早期研究中使用的二氧化碳激光能量源外，使用钬：钇铝石榴石激光和准分子激光的替代设备的试验也正在进行中。后两者采用光纤技术，目前正在开发用于血管内治疗方法。
