from the June 2009 issue

New treatment of intractable angina and a non-invasive way of producing blood vessels

Chest pain is a dominant symptom that brings patients to seek medical help. A common cause is the narrowing of the coronary arteries due to arteriosclerosis. In the last three decades, enormous advances have been made in the treatment of coronary artery disease, the number one killer in the Western World. Preventive measures including diet, exercise, cholesterol lowering drugs and treatment of hypertension have resulted in a dramatic decrease in the mortality from heart attacks and angina pectoris. Coronary artery bypass and cardiac catheterization with implantation of stents have resulted in alleviation of symptoms of angina pectoris and prolongation of life. However, there is a growing number of patients who have undergone bypass surgery and often multiple angioplasties, but remain with disabling symptoms of angina pectoris despite optimal medical therapy. In fact multiple reports of the results of angioplasty and bypass surgery in carefully controlled trials show that at a year after both procedures, up to 25% of patients had symptoms of angina pectoris, despite optimal treatment. These patients, with intractable angina, are not candidates for further interventional procedures, and yet remain cardiac cripples or have severe limitation of effort.

A new promising non-invasive treatment has been developed by Cardiospect, a company that manufactures and markets a device that produces high energy ultrasound shock waves for lithotripsy, (breaking up stones in the kidneys and ureter) . This machine has been modified to produce low energy shock waves (one tenth that required for lithotripsy). Based on laboratory and animal experiments, repetitive low energy shockwaves applied outside the body, stimulate the development of new blood vessels in the designated area of the ischemic area of the heart muscle by releasing cytokines and homing factors for the progenitor cells ("healing cells") in the circulation. This has been repeatedly demonstrated in many centers in Europe and in two centers in Israel. The shock waves are focused and guided to the ischemic muscle with conventional ultrasound. The out-patient treatment is painless, does not cause damage to the treated heart, lasts about 30 minutes for the application of about 500 "shocks". Optimal stimulation of blood vessel formation is obtained by a series of 9 treatments, 3 per week, at 4 weekly intervals. Professor Hylton Miller, an interventional cardiologist, and a member of the Advisory Board of IHTIR has seen marked improvement in radionuclear myocardial perfusion scans following Shock-Wave Therapy in a series of patients, a phenomenon he has seen only in patients who have undergone revascularization by by-pass surgery or angioplasty. These results have been reported on in multiple European centers.

Alternative non-invasive treatments include EECP - Enhanced External counter-pulsation. This involves three cuffs placed on each leg (on the calves, the lower thighs, and the upper thighs (or buttock)). The cuffs are timed to inflate and deflate based on the individual's electrocardiogram. The number of ECP treatment sessions is a total of 35 one hour sessions over 7 weeks.The results are modest, unpredictable and patients with peripheral vascular disease are not suited for this therapy. In development are attempts at cell therapy for chronic angina, but no dramatic results have been report. It is not widely used, and is invasive, complex and the cost is high. External Shock-Wave Myocardial Revascularization (ESMR) is an effective and patient friendly modality for the stimulation of angiogenesis and for treatment of patients with intractable angina and is poised to become a more widely used treatment for the growing population of patients with intractable angina. Studies are underway using shock wave therapy in patients with chronic heart failure and as an adjunct homing stimulus for cell therapy.

Reprinted from the Israel High-Tech & Investment Report June 2009

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