Changes in myocardial perfusion after catheter-based percutaneous laser revascularisation.

Abstract

This study investigated the effect of percutaneous laser revascularisation (PMR) on regional myocardial blood flow. PMR is a new therapeutic modality for patients suffering from angina pectoris due to coronary artery disease (CAD) that is not amenable to revascularisation. Initial clinical studies discovered reduced angina pectoris and increased exercise capacity after PMR. There are no previous clinical studies reporting the impact of PMR on perfusion. Thirty-six patients with end-stage CAD underwent thallium-201 single-photon emission tomography studies on four different occasions: immediately before PMR and 3, 6 and 12 months following PMR. Each study consisted of pharmacological stress and rest scintigraphy. Semiquantitative evaluation was performed by use of 14 standardised wall segments which were classified (a) according to the localisation of the PMR target region into treated segments, segments adjacent to the treated area and non-treated segments and (b) according to the pre-therapeutic local perfusion into four groups: no (0), slight (I), moderate (II) or severe (III) perfusion deficit. At stress in treated segments of groups II and III local scintigraphic count densities increased from 60.1% and 34.7% at baseline to 65.3% and 48.3% after 12 months (P<0.05) while they decreased in segments of group 0 from 94.2% to 85.7% (P<0.05). In rest studies no changes occurred. Thus, the local rest-stress differences within the target areas become smaller after PMR. In the PMR target area but not in the nontreated area an improvement in regional myocardial flow reserve occurs in wall segments with initially severely or moderately reduced stress perfusion. This effect is consistent with the clinical improvement after PMR.