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A prospective, multicenter, randomized trial of percutaneous transmyocardial laser revascularization in patients with nonrecanalizable chronic total occlusions

Gregg W. Stone, MD, FACC^*,*, Paul S. Teirstein, MD, FACC, Ronald Rubenstein, MD, FACC, Dwayne Schmidt, MD, FACC, Patrick L. Whitlow, MD, FACC^||, Edward J. Kosinski, MD, FACC^¶, Gregory Mishkel, MD, FACC^# and John A. Power, MD, FACC^**

^* Cardiovascular Research Foundation, New York, New York, USA
Scripps Clinic and Research Institute, La Jolla, California, USA
Jersey Shore Medical Center, Neptune, New Jersey, USA
Presbyterian Hospital, Oklahoma City, Oklahoma, USA
^|| Cleveland Clinic Foundation, Cleveland, Ohio, USA
^¶ St. Vincent’s Medical Center, Bridgeport, Connecticut, USA
^# St. John’s Hospital and Memorial Medical Center, Springfield, Illinois, USA
^** St. Francis Hospital, Lawrenceville, Pennsylvania, USA

View larger version (14K): [in a new window]   Figure 1 Vessel distribution of chronic total occlusions that were unsuccessfully dilated in patients randomized to percutaneous transmyocardial revascularization (PTMR) versus maximal medical therapy (MMT). LAD = left anterior descending coronary artery; LCX = left circumflex coronary artery; RCA = right coronary artery.

View larger version (17K): [in a new window]   Figure 2 Canadian Heart Association angina class at six months in the study group. PTMR = percutaneous transmyocardial revascularization; MMT = maximal medical therapy.

View larger version (18K): [in a new window]   Figure 3 Results of the pre-discharge questionnaire of treatment assignment. PTMR = percutaneous transmyocardial revascularization; MMT = maximal medical therapy.

View larger version (16K): [in a new window]   Figure 4 Improvement in exercise duration from baseline to six months in patients randomized to percutaneous transmyocardial revascularization (white bars) with the Eclipse holmium/yttrium aluminum garnet laser versus maximal medical therapy (black bars) in the present study (patients with non-revascularizable chronic total occlusions (CTOs); left bars) compared with a previous study with the same device in a different patient group (patients with end-stage ischemic heart disease with no revascularization options; right bars).