Abstract

Current interventional options for the treatment of coronary artery disease often fail to revascularize the distal segments of atherosclerotic arteries. Even when a target for bypass graft anastomosis can be identified along the diseased vessel, distal run-off from that graft cannot be maximized if arterial narrowing is of a diffused nature. Over the past decade, transmyocardial laser revascularization (TMLR) with or without coronary artery bypass grafting (CABG) or percutaneous transluminal coronary angioplasty (PTCA) has been proposed as a solution to this problem. TMLR is thought to work by shunting left ventricular blood directly into the ischemic myocardium via laser- mediated channels. Although extensive clinical trials suggest a cause-effect relationship between these channels and the improvement in angina, the procedure remains controversial. The different levels of this controversy are the subject of this paper.

© 1998 Optical Society of America