Abstract
Arteriogenesis as a way to restore blood flow after arterial occlusion has been under investigation for the treatment of coronary artery disease (CAD) for decades. Therapeutic approaches so far have included delivery of cytokines and growth factors as well as mechanical stimulation such as external counterpulsation. As knowledge on the mechanisms of arteriogenesis expanded, new therapeutic approaches have emerged.This review summarizes recent attempts to stimulate the growth of the coronary vasculature and discusses their potential in clinical application. This article also delivers an overview of current studies and trials on coronary arteriogenesis.
Highlights
For decades ischemic heart disease (IHD) has been the leading cause of death in industrialized western societies [1]
Macrovascular atherosclerosis leading to coronary artery obstruction and impairment of blood flow towards myocardial tissue is the underlying pathophysiology leading to IHD
Outcome Increase in coronary collateralization, increase of coronary flow index (CFI) Increase in coronary collateralization, combined with exercise No difference in angina frequency or exercise tolerance Non-significant increase in exercise-time after 4 weeks No difference in exercise tolerance when compared to placebo Increase in CFI, terminated when 2 patients developed acute coronary syndromes (ACS) Increase in CFI, more often lack of stent revascularization (ST)-segment elevation Increased CFI compared to Sham treatment
Summary
For decades ischemic heart disease (IHD) has been the leading cause of death in industrialized western societies [1]. The application of this substance had been validated in several different animal models and showed an increase of the coronary flow index in the 11 CAD patients included in the study when compared to placebo treatment [18]. Treatment with NPY resulted in up-regulation of proarteriogenic proteins while down-regulating anti-angiogenic factors [27] and could be another possible target for the stimulation of collateral artery growth in the future.
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