Laser revascularisation.

Patients who present with angina pectoris due to underlying coronary artery disease which is not controlled by medical therapy, and who have disease which is not amenable to conventional forms of revascularisation, present an increasing clinical problem. Laser techniques have been introduced to improve myocardial perfusion in this group of patients. The surgical technique of transmyocardial laser revascularisation has been evaluated in this patient population. Generally, there has been a good symptomatic response in terms of improvement in angina, and in some studies an increase in exercise capacity. The technique, however, does carry significant morbidity and mortality. More recently, a catheter-based technique has been introduced--percutaneous myocardial laser revascularisation. This technique seems to improve symptoms of angina, produce an increase in exercise capacity, with a much more favourable procedural risk profile.