Abstract
The mechanism of transmyocardial laser-induced reduction in angina symptoms remains elusive. Proposed mechanisms of the symptomatic relief afforded by transmyocardial laser revascularization (TMLR) include improvement in myocardial perfusion due to angiogenesis, myocardial denervation, and a placebo effect. The uncertain mechanism of TMLR effect notwithstanding, the degree of angina relief in randomized and retrospective studies has been remarkably consistent with little apparent variation as a function of the laser wavelength utilized. The early benefits in terms of angina relief appear to be largely sustained at follow-up to 5 years. In the increasingly elderly and comorbid population of patients with coronary artery disease, additional treatment modalities are clearly needed to relieve intractable symptoms and improve quality of life. Based on an appropriate risk adjustment algorithm, many of these patients may not be ideal candidates for revascularization. Thus, although an improvement in long-term survival is desirable, there is a definite niche for a form of therapy that only provides symptomatic relief, provided that it does not harm the patient in the process.
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