The Combined Use of Transmyocardial Laser Revascularisation and Intramyocardial Injection of Bone-Marrow Derived Stem Cells in Patients with End-Stage Coronary Artery Disease: One Year Follow-Up

BACKGROUND:

There are a growing number of patients with end-stage coronary artery disease (CAD) and refractory angina. Angiogenesis may be induced by intramyocardial injection of autologous bone marrow stem cells, intensified by inflammationaround channels performed by laser.

AIM:

To assess the effect of a combined treatment consisting of transmyocardial laser revascularisation (TLMR) and intramyocardialinjection of bone-marrow derived stem cells (bone marrow laser revascularisation, BMLR) in patients with refractoryangina one year after the procedure.

METHODS:

Five male patients (age 49-78 years) with end-stage diffuse CAD, severe angina (CCS III/IV) despite intensive medicaltherapy and disqualified from prior coronary artery bypass grafting (CABG) or percutaneous coronary intervention wereincluded. After heart exposure, at sites where CABG was impossible, TMLR was performed with the Holmium: YAG laser combinedwith injection of 1 mL of bone marrow concentrate into the border zone of a laser channel using a Phoenix handpiece.

RESULTS:

No deaths in the follow-up period were observed. All patients were in I CCS Class. One year after the procedure,left ventricular (LV) segments treated by BMLR tended to demonstrate stronger myocardial thickening compared to baseline(53.0 ± 7.5% vs. 45.0 ± 9.5%; p = 0.06). Using late gadolinium-enhanced imaging, new myocardial infarction was foundafter one year only in one LV segment treated by BMLR. The BMLR treated regions in the remaining subjects, as well asregions subtended by left internal thoracic artery in two subjects, did not show new myocardial infarction areas. In contrast,all subjects who underwent only BMLR procedure revealed new and/or more extensive myocardial infarct in regions nottreated by BMLR.

CONCLUSIONS:

Intramyocardial delivery of bone marrow stem-cells together with laser therapy is a safe procedure, with improvementin quality of life during follow-up. One year after the procedure, myocardial regions where BMLR was performedtended to demonstrate stronger myocardial thickening observed in cardiac magnetic resonance imaging.