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Therapeutic angiogenesis for management of refractory angina

Michael Simons, MD
Section Editor
Bernard J Gersh, MB, ChB, DPhil, FRCP, MACC
Deputy Editor
Gordon M Saperia, MD, FACC


Advances in medical therapy and mechanical revascularization have significantly improved outcomes and the quality of life in patients with angina pectoris. In addition, the widespread application of drug-eluting stents has greatly expanded the ability of percutaneous coronary intervention (PCI) to treat patients with complex coronary anatomy. (See "Stable ischemic heart disease: Overview of care" and "Stable ischemic heart disease: Indications for revascularization" and "Revascularization in patients with stable coronary artery disease: Coronary artery bypass graft surgery versus percutaneous coronary intervention".)

Despite these advances, there are patients with angina that is refractory to medical therapy who are not candidates for traditional revascularization (PCI or coronary artery bypass graft surgery [CABG]) because of the inability to achieve complete revascularization or the high risk of CABG [1].

Such patients provide part of the rationale for novel therapeutic strategies to improve both prognosis and the quality of life. Therapeutic angiogenesis is one such option and will be reviewed here [2,3]. This approach is also being investigated for treatment of patients with peripheral artery disease, including both intermittent claudication and critical limb ischemia. (See "Investigational therapies for treating symptoms of lower extremity peripheral artery disease", section on 'Therapeutic angiogenesis'.)

Other investigational strategies, such as transmyocardial laser revascularization and new medications, are discussed separately. (See "Transmyocardial laser revascularization for management of refractory angina" and "New therapies for angina pectoris".)


The goal of therapeutic angiogenesis is the induction of new coronary arterial vessels that can effectively provide blood supply to the area of myocardium subtended by diseased or occluded native coronary arteries. These "native bypass" vessels could then relieve myocardial ischemia, improve regional and global left ventricular performance, lessen symptoms of angina, and potentially improve patient prognosis [4].

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Literature review current through: Nov 2017. | This topic last updated: Nov 20, 2017.
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