Epicardial gene therapy and laser revascularization.

Despite the proven effectiveness of coronary bypass surgery and percutaneous angioplasty techniques, an increasing number of patients are presenting with severe, medically intractable angina who are not candidates for either procedure. Two alternative strategies, transmyocardial laser revascularization and exogeneous administration of angiogenic growth factors (therapeutic angiogenesis) are currently being evaluated in such patients. This review focuses on the current status of these two procedures, emphasizing their similarities and differences in order to provide insight into what role each may ultimately play in the management of patients with otherwise unrevascularizable myocardial ischemia.