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Catheter-based percutaneous myocardial laser revascularization in patients with end-stage coronary artery disease

Bernward Lauer, MD^*, Ulrike Junghans, MD^*, Fabian Stahl, MD^*, Regina Kluge, MD, Stephen N. Oesterle, MD and Gerhard Schuler, MD^*

^* Klinik für Innere Medizin/Kardiologie, Universität Leipzig-Herzzentrum GmbH, Leipzig, Germany
Klinik für Nuklearmedizin, Universität Leipzig, Leipzig, Germany
Department of Cardiology, Stanford Medical Center, Stanford, California, USA

View larger version (131K): [in a new window]   Figure 1 (A) Percutaneous myocardial revascularization catheter system consisting of guiding catheter (blue), laser catheter (white) and laser fiber (tip) showing multiple possibilities for longitudinal and rotational adjustments. (B) Tip of the laser fiber with lens and nitinol petals.

View larger version (23K): [in a new window]   Figure 2 Angina pectoris and use of additional nitrates of 17 patients at baseline and three and six months after percutaneous myocardial revascularization, respectively. Anginal symptoms were recorded according to the Canadian Cardiologic Society Angina Scale (CCS class). Use of nitrates was recorded on a semiquantitative scale (see Methods section). Solid box = CCS class; striped box = use of nitrates.

View larger version (18K): [in a new window]   Figure 3 Exercise time on standard bicycle ergometry of 17 patients at baseline and three and six months after percutaneous myocardial revascularization, respectively (Box-Whisker-Plot).

View larger version (49K): [in a new window]   Figure 4 Myocardial perfusion in 201Tl-scintigraphy of 17 patients at baseline and three and six months after percutaneous myocardial revascularization, respectively. Myocardial perfusion was quantitated by measurement of 201Tl uptake in the laser-treated regions compared with the non-lasered septum (septum = 100%). (A)Stress induced by injection of 0.54 mg/kg body weight of dipyridamole. Striped box = stress; solid box = rest. (B) Ischemia induced by standard bicycle ergometry. Striped box = exercise; solid box = rest.