These agents include nitrates, beta-blockers and calcium channel blockers. The predicament some patients find themselves in however is that they were being referred for revascularization procedures because they already failed medical therapy. The patient who has ongoing angina, in spite of maximal medical therapy and who is not a candidate for CABG or PTCA, has a very high mortality. Patient prognosis in these cases is often viewed as terminal. The goal of PTMR is to provide these patients with some hope of a viable treatment option.
Mild sedation is used, just as for coronary angioplasty.
A sheath is placed in the femoral artery. A 9 French guiding catheter is threaded over a J-wire into the left ventricle. Approximately 12 to 15 channels are made in one ischemic zone or wall of the left ventricle. Up to two ischemic zones can be treated in one setting. Figure 1 .