Neovascularization after transmyocardial laser revascularization in a model of chronic ischemia.

Journal Article

BACKGROUND: The mechanism of clinical improvement after transmyocardial laser revascularization (TMR) is unknown. One hypothesis holds that TMR causes increased myocardial perfusion through neovascularization. This study sought to determine whether angiogenesis occurs after TMR in a porcine model of chronic myocardial ischemia. METHODS: Six miniature pigs underwent subtotal left circumflex coronary artery occlusion to reduce resting blood flow to 10% of baseline. After 2 weeks in the low-flow state, dobutamine stress echocardiography and positron emission tomography were performed to document ischemic, viable myocardium. The animals then underwent TMR and were sacrificed 6 months later for histologic and immunohistochemical analysis. RESULTS: Histologic analysis of the lased left circumflex region demonstrated many hypocellular areas filled with connective tissue representing remnant TMR channels. Histochemical staining demonstrated a highly disorganized pattern of neovascularization consistent with angiogenesis located predominantly at the periphery of the channels. Immunohistochemical analysis confirmed the presence of endothelial cells within neovessels. Vascular density analysis revealed a mean of 29.2+/-3.6 neovessels per high-power field in lased ischemic myocardium versus 4.0+/-0.3 (p<0.001) in nonlased ischemic myocardium. CONCLUSIONS: This study provides evidence that neovascularization is present long term in regions of ischemic, viable myocardium after TMR. Angiogenesis may represent the mechanism of clinical improvement after TMR.

Full Text

Duke Authors

Cited Authors

  • Hughes, GC; Lowe, JE; Kypson, AP; St Louis, JD; Pippen, AM; Peters, KG; Coleman, RE; DeGrado, TR; Donovan, CL; Annex, BH; Landolfo, KP

Published Date

  • December 1998

Published In

Volume / Issue

  • 66 / 6

Start / End Page

  • 2029 - 2036

PubMed ID

  • 9930489

International Standard Serial Number (ISSN)

  • 0003-4975

Language

  • eng

Conference Location

  • Netherlands