OPTIMAL CARDIAC NEOVASCULARISATION BY USING SHOCK WAVE THERAPY – ESMR BACKGROUND: The majority of patients suffering from IHD can be adequately treated by drug therapy and revascularization procedures like PTCA & CABG. How-ever, there are still patients who remain severely disabled by myocardial ischemia related symptoms i.e. angina & dyspnea. As a result of the im-provements of cardiovascular care this group of patients is rapidly increas-ing. (COURAGE study, NHBLI registry - ~25% not free from angina ). Cur-rent therapy options for these patients are limited and mostly highly inva-sive. ESMR – Extra Corporeal Shockwave Myocardial Revascularization is a new treatment option for patients with advanced coronary artery disease, not suit-able for conventional revascularization therapy. WHAT ARE SHOCKWAVES: Shockwaves are special acoustic waves that can be targeted and focused non-invasively to a selected area inside the patient body. Shockwave thera-pies have been used in the last decade in Urology (Lithotripsy) & Orthope-dics. In - vitro and animal data show an increase of angiogenic factor and neo-vascularization after treatment of low intensity shockwaves. Therapeutic effect of shockwave is localized, precise and controlled. PHYSIOLOGICAL EFFECTS OF ESMR; • Short term effect – Local vasodilatation • Long term effect – Angiogenesis i.e. the induction of neovasculariza-tion in treated tissue. Effect Shear Stress Intracellular & Extracellular responses . Stimulates endothelial Nitric Oxide Synthase (eNOS) Release of Vascular Endothelial Growth Factors (VEGF) Proliferating Cell Nuclear Antigen (PCNA) production Angiogenesis Shock Waves Angiogenesis Effect WHY ESMR: Patients with advanced CAD frequently have recurrent Angina. Surgical and interventional options for these patients typically have been ex-hausted or will result in only partial revascularization. ESMR offers new hope for these patients and provides therapy which complement existing treatment procedures. The number of patients with persistent Angina despite PCI is increasing due to improvement in revascularization procedures. Between 15-25% of pa-tients undergoing revascularization procedures will not be free from angina one year after the procedure. Therapy to these patients is invasive or mostly used on medication. Patient medical history of interventions determine the risk to have repeated angina. The more interventions the patient had the higher the chance to have angina again. It is also the treatment indicated for patients who no longer benefit from current revascularization method due to - 1. Large number of occluded small arteries (
Posted on: Thu, 06 Jun 2013 17:02:42 +0000
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