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.