Percutaneous in situ venous arterialisation

Area of Science:

• Cardiovascular Medicine
• Interventional Cardiology
• Biomedical Engineering

Background:

• Approximately 5% of patients annually lack viable therapeutic options due to diffuse coronary artery disease.
• Traditional treatments like angioplasty, stenting, and bypass surgery are not feasible when there's no discrete target.
• Retrograde myocardial perfusion via the venous system has historical precedent in surgical approaches for "ungraftable" patients.

Purpose of the Study:

• To evaluate the feasibility and safety of Percutaneous in situ venous arterialisation (PICVA) as a novel catheter-based coronary bypass technique.
• To assess PICVA's potential as a therapeutic option for patients with diffuse coronary disease and no other treatment alternatives.

Main Methods:

• PICVA utilizes unique catheter-based devices to create an arterialised segment of a coronary vein.
• This arterialised vein segment facilitates retrograde perfusion of ischaemic myocardium.
• The study involved the first eleven percutaneous applications of this catheter-based coronary bypass in human patients within the PICVA European Safety trial.

Main Results:

• The study demonstrated the feasibility of the PICVA technique in highly symptomatic patients with limited therapeutic options.
• Despite challenges, including two deaths and six instances where a connection could not be established, the procedure showed potential.
• Pre-clinical animal studies indicated that PICVA could reduce ischaemia and myocardial damage in infarction models.

Conclusions:

• Percutaneous in situ venous arterialisation (PICVA) represents a potentially viable, albeit early-stage, catheter-based approach for coronary bypass.
• Further development of this veno-arterial coronary bypass technique is warranted for inoperable and undilatable patients.
• PICVA may offer a future therapeutic avenue for a subset of patients with complex coronary artery disease currently lacking treatment options.