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With the growing age of the general population, the proportion of
elderly patients with diffuse coronary artery disease and severe
comorbidities is increasing. When medical therapy cannot relieve
the symptoms in these patients, their characteristics render them
unsuitable for currently rec- ognized invasive procedures, namely
coronary artery bypass grafting and percutaneous transluminal
angioplasty. There is an urgent need for new treatment modalities
which can alleviate their symptoms and increase blood flow to the
ischemic myocardium while being less inva- sive for their fragile
condition. The idea for this book was to relate my personal
experience in the research and clinical fields and the current
state of knowledge as reported in the literature. An additional aim
was to provide anatomical and physiological background as well as a
complete review of the new methods of revascularization currently
being developed. To this purpose, I have analyzed many studies on
the microvascula- ture of the heart, the historical forerunners of
the new procedures, and the new treatment modalities themselves:
transmyocardiallaser revascu- larization, therapeutic angiogenesis,
and neurostimulation. I wish to thank my teachers in surgery,
cardiology, and medicine: B. Faidutti (Geneva), J.-P. Berger
(Vevey), 1. Kappenberger (Lausanne), F. Harder (Basel), T. Amery
(Frimley), K. Arnold (Brig), and especially 1.K.
With the growing age of the population, the proportion of elderly
patients with diffuse coronary artery disease and severe
comorbidities is increasing. The characteristics of these patients
render them unsuitable for currently recognized revascularization
procedures (CABG, PTCA). Therefore, there is an urgent need for new
treatment modalities which could alleviate their symptoms and
increase blood flow to the ischemic myocardium, while being less
invasive for their fragile condition. The aim of this book is to
provide an anatomical and physiological background as well as a
complete review of the alternative methods of revascularization
which are under development, namely transmyocardial laser
revascularization, therapeutic angiogenesis and neurostimulation.
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