Angiogenesis in transmyocardial laser revascularization : A nonspecific response to injury. Commentary

Background-The mechanism of action of transmyocardial laser revascularization (TMR) is poorly understood. TMR has been shown to stimulate angiogenesis in porcine and canine myocardium. Methods and Results-We examined the possibility that angiogenesis also occurs in ovine myocardium and that it is a nonspecific tissue injury response. Five Dorset sheep underwent creation of transmyocardial channels of equal diameter in both the apical and basal regions of the left ventricle through the use of both CO 2 laser in I region and a power drill in the alternate region of the same heart. All channels were closed at 4 weeks. Histology showed channel remnants composed of granulation tissue, fibrosis, and new vessels (NV). These changes were not distinguishable on the basis of the method of channel creation. The average diameter of the channels was similar (laser, 630±180 μm; drill, 750±280 μm) (P=NS). NV with smooth muscle media were seen within the channel remnant and immediately surrounding this region using Verhoeff-Van Gieson (elastic) stain. The densities of the NV within the channel remnants were similar (laser, 1.87±1.05 NV/high-power field [hpf]; drill, 1.92±1.09 NV/hpf; P=NS), and both were significantly greater than the density of vessels in remote regions, >5 mm from the channel center (remote laser area, 0.09±0.28 NV/hpf; remote drill area, 0.04±0.21 NV/hpf; P=NS for remote areas, P<0.001 for laser versus remote laser, P<0.001 for drill versus remote drill area). Conclusions-These findings demonstrate that the CO 2 laser stimulates angiogenesis in normal ovine myocardium and suggest that this response represents a nonspecific reaction to tissue injury.