Kohmoto T, DeRosa C M, Yamamoto N, Fisher P E, Failey P, Smith C R, Burkhoff D
Department of Surgery, Columbia Presbyterian Medical Center, New York, New York, USA.
Ann Thorac Surg. 1998 May;65(5):1360-7. doi: 10.1016/s0003-4975(98)00236-7.
Transmyocardial laser revascularization is a new therapy for patients with refractory angina. Although clinical studies suggest that transmyocardial laser revascularization decreases angina and may improve regional blood flow, the underlying mechanisms are not elucidated. We hypothesized that one mechanism may relate to stimulation of vascular growth in laser-treated regions.
Transmyocardial laser revascularization channels were made with holmium:yttrium-aluminum garnet or carbon dioxide lasers in eight normal canine hearts; animals were sacrificed 2 to 3 weeks later and examined for vascular density and for evidence of smooth muscle proliferation.
The original channels were infiltrated by granulation tissue with associated vascularity. Vascular growth was stimulated immediately surrounding the channel remnant as evidenced by an increase in the number of vessels (approximately twice that of the control region) and an increase in the number of vascular cells staining positive for markers of cellular proliferation.
Transmyocardial laser revascularization leads to local vascular growth as early as 2 weeks after treatment. It remains to be determined whether this mechanism contributes to increased regional blood flow or to clinical benefits associated with this novel form of therapy.
心肌激光血运重建术是一种针对顽固性心绞痛患者的新疗法。尽管临床研究表明心肌激光血运重建术可减轻心绞痛并可能改善局部血流，但其潜在机制尚未阐明。我们推测一种机制可能与激光治疗区域的血管生长刺激有关。
用钬：钇铝石榴石激光或二氧化碳激光在8只正常犬心脏中制作心肌激光血运重建通道；2至3周后处死动物，检查血管密度及平滑肌增殖证据。
原始通道被伴有血管的肉芽组织浸润。通道残余周围立即刺激血管生长，表现为血管数量增加（约为对照区域的两倍）以及对细胞增殖标志物染色阳性的血管细胞数量增加。
心肌激光血运重建术在治疗后2周即可导致局部血管生长。这种机制是否有助于增加局部血流或与这种新疗法相关的临床益处，仍有待确定。
