Therapeutic angiogenesis in patients with advanced coronary artery disease: Hype or hope?

A single aorto-coronary venous bypass grafting procedure attaching a vein end-to-end to the proximal right coronary artery was first performed by Favaloro in Cleveland.(1,2) Complex distal venous bypasses from the aorta to the side of the coronary vessels were first used by Johnson(3-6) in Milwaukee. These two developments contributed the most to the development of modern revascularization operations which are now the most frequent surgical interventions in the world. Coronary artery bypass surgery, and later coronary angioplasty, significantly improved the results of the treatment of patients with coronary artery disease, reducing mortality and improving the quality of life. However, the efficacy of both methods of treatment for advanced coronary artery disease is limited. In patients with diffuse distal disease, it is impossible to perform balloon angioplasty, stent implantation, or bypass grafting. Endarterectomy over a portion of or over all of a coronary system is an alternative approach, but this carries measurably increased risk over the other therapies; with extension of atherosclerosis into the 3rd and 4th branches of arteries, or with obliteration of arteries after failed grafts, endarterectomy is not possible. There is a significant restenosis rate after all coronary interventions, some sooner, some later.