Percutaneous Myocardial Revascularization

 A new procedure offers a new approach for treating angina in patients with previously untreatable disease. In this procedure, which is still under trial by the FDA, the interventional cardiologist uses a laser catheter to create small channels in the heart wall from within the heart. The purpose of the channels is to provide blood irrigation to the heart muscle from within the heart.

The Percutaneous Myocardial Revascularization (PMR) procedure, which takes about two hours, is done in the cardiac catheterization lab using a fiberoptic catheter inside a guiding catheter. The cardiologist inserts the guiding catheter through the femoral artery into the left ventricle. The fiberoptic catheter is then inserted through the guiding catheter, and is then positioned against the interior wall of the left ventricle in the area suffering from blood starvation (ischemia). Once the fiberoptic catheter is in position, the cardiologist activates a holmium laser connected to the fiberoptic catheter to create a small channel. The procedure is repeated, creating enough channels about 1 cm. apart to cover the blood-starved area of the heart muscle.

Although the channels created by this procedure eventually heal and recede, the goal is the creation of new blood vessels. The PMR channels seem to promote the generation of new blood vessels in the areas around the channels, and this increases internal irrigation of the heart muscle with oxygen-rich blood. It is hoped that these new blood vessels will continue supplying the needed nutrients and oxygen to the heart muscle for a long-term after the original PMR channels recede.