Myocardial revascularisation by laser

Myocardial revascularisation by laser is an emerging treatment for refractory angina in patients with coronary artery disease that is not amenable to conventional revascularisation. With the original technique, laser energy was applied to epicardial surface of the heart through a lateral thoracotomy; so-called transmyocardial laser revascularisation (TMR). It is now possible, using catheter-based percutaneous myocardial revascularisation (PMR) to deliver laser energy to the myocardium via the endocardial surface. In this article we discuss the possible mechanism of action of laser revascularisation, and summarise the results of recent randomised controlled trials of TMR, PMR systems are described, and the growing evidence for their efficacy is reviewed.