Therapeutic Angiogenesis for the Management of Refractory Angina: Current Concepts

The optimal treatment of coronary artery disease (CAD) involves reducing the ischemic burden, lowering the risk of future adverse cardiac events, and relieving symptoms of angina pectoris. Medical and mechanical therapies have played a major role in reducing the morbidity and mortality associated with ischemic heart disease. Despite the success of these conventional therapies, there are patients with CAD who continue to experience angina despite maximal medical and revascularization therapy. Therapeutic angiogenesis represents a novel treatment option for these "no-option" patients with refractory ischemic coronary disease. A growing body of evidence has demonstrated the therapeutic potential of therapeutic angiogenesis with gene, protein, or cell-based therapies. The goal of therapeutic angiogenesis is to induce the formation of new vessels that can enhance blood flow to areas that no longer have adequate blood supply. While the existing data are not definitive, there is reason to be optimistic, as several studies have suggested a clinical benefit. This review focuses on the current state of therapeutic angiogenesis in the management of the "no-option" patient with refractory angina.