BACKGROUND Patients with chronic severe angina refractory to medical therapy who cannot be completely revascularized with either percutaneous catheter intervention or coronary artery bypass graft surgery present clinical challenges. Transmyocardial laser revascularization, either as sole therapy or as an adjunct to coronary artery bypass graft surgery, may be appropriate for some of these patie...

Ischemic heart disease (IHD) is a main determinant of global health and mortality. Despite significant advances in therapeutic options, many patients complain with persistent symptoms and/or signs of myocardial ischemia (ie, refractory angina). Main therapeutic strategies used in angina patients aim at either reducing the effects of coronary stenosis on coronary blood flow or at removing the co...

OBJECTIVE: To describe the epidemiology, impact, pathogenesis, patient presentation, and treatment of stable angina, including the use of vasculoprotective and antianginal drug therapies and coronary revascularization procedures. SUMMARY: Stable angina is an age-related condition that typically affects men at an earlier age than women, adversely affects quality of life, and increases mortality....

BACKGROUND Platelet aggregation is a dominant feature in the pathophysiology of unstable angina. Percutaneous transluminal coronary angioplasty (PTCA) in patients with this disorder carries an increased risk of thrombotic complications. Abciximab (c7E3) blocks the platelet glycoprotein IIb/IIIa receptor, thus preventing platelet adhesion and aggregation. The CAPTURE study was a randomised place...

BACKGROUND Patients with refractory angina pectoris in end-stage coronary artery disease represent a severe condition with a higher reduction of life-expectancy and quality of life as compared to patients with stable coronary artery disease. It was the purpose of this study to invasively re-evaluate highly symptomatic patients with formerly diagnosed refractory angina pectoris in end-stage coro...

B ecause the mortality for ischemic heart disease has improved, an increasing number of patients exhaust their revascularization options and are left with refractory angina. Previous studies suggested that up to 15% of patients undergoing catheterization are suboptimal candidates for further revas-cularization. 4 This number may be growing because a recent analysis from the Duke Databank for Ca...

Over recent decades, the numerous coronary revascularisation procedures performed either by percutaneous coronary intervention (PCI), or coronary bypass surgery has led to an increasing number of patients who are no longer eligible for additional revascularisation procedures. This number of patients is expected to rise even further in view of an increase in life expectancy in patients with coro...

BACKGROUND Transmyocardial laser revascularization (TMLR) is an alternative treatment modality for patients with refractory angina who are not candidates for conventional surgical or percutaneous revascularization. Clinical studies of TMLR have not shown one-to-one correlation between increased myocardial perfusion and improved clinical status. METHODS Three patients (51, 53, and 70 years old...

It has been shown that the incidence of vasospastic angina pectoris is more frequent in Japanese people than in Caucasians, and calcium channel blockers and/or nitrates were effective in these patients [1]. Conversely, it has been claimed that about 20% of cases are not treated effectively with combined administration of calcium channel blocker and nitrate [2]. In refractory cases, it has been ...

OBJECTIVE We tested the hypothesis that TMLR combined with intramyocardial injection of BMC is safe, and may help increase the functional capacity of patient with refractory angina. METHODS Nine patients (eight men), 65+/-5 years old, with refractory angina for multivessel disease and previous myocardial revascularization procedures (CABG/PCI), not candidates for another procedure due to the ...