Article Text

Download PDFPDF
Angiogenesis in chronically ischaemic human heart following percutaneous myocardial revascularisation
  1. J M Cotton1,
  2. M R Thomas1,
  3. B J Dunmore,
  4. J Salisbury2,
  5. A M Shah1,
  6. N P J Brindle3
  1. 1Department of Cardiology, King's College Hospital and Guy's, King's & St Thomas's Medical School, Denmark Hill, London SE5 9PJ, UK
  2. 2Department of Histopathology, King's College Hospital and Guy's, King's & St Thomas's Medical School
  3. 3University of Leicester Cardiovascular Research Institute and Department of Surgery, RKCSB, PO Box 65, Leicester LE2 7LX, UK
  1. Correspondence to:
    Professor Ajay Shah, Department of Cardiology, King's College Hospital and Guy's, King's & St Thomas's Medical School, Denmark Hill, London SE5 9PJ, UK;

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Patients with intractable angina and severe diffuse coronary artery disease not amenable to conventional revascularisation therapy have relatively few treatment options. A number of studies suggest myocardial laser revascularisation is of clinical benefit in such patients.1, 2 Percutaneous myocardial revascularisation (PMR) involves the use of an intravascular catheter, positioned within the left ventricular cavity under fluoroscopic guidance, to deliver controlled bursts of holmium:YAG laser energy. PMR results in the formation of small channels (∼1.75 mm diameter) that extend from the endocardial surface partly into the myocardial wall. Many uncontrolled studies suggest that PMR provides symptomatic relief, although the first randomised controlled trial demonstrated no benefit over a sham procedure.3 It has been suggested that PMR induces angiogenesis, although many other mechanisms of action have been suggested.

To determine whether PMR has any effects on angiogenesis in the human ischaemic myocardium we have undertaken a detailed histological and immunohistochemical examination of the hearts of two patients who died eight weeks and 52 weeks after apparently symptomatically successful PMR therapy. In this first detailed study of human myocardium subjected to percutaneous myocardial laser revascularisation, we report evidence of sustained myocardial neovascularisation in treated areas and of the presence of vascular endothelial growth factor (VEGF). Unexpectedly, most of the neovessels are abnormal and immature, lacking a smooth muscle coat. Furthermore, neovessels are largely confined to scar tissue. Both the above factors are likely to limit the extent to which angiogenesis following PMR could improve perfusion. In a broader context, …

View Full Text