New Trends in Coronary Revascularization: Neoangiogenesis by Human Growth Factors

This article is a report of our clinical experience with the human growth factor FGF as applied to the ischemic human myocardium. After the completion of extensive preliminary animal experiments, the growth factor FGF, obtained from genetically manipulated Escherichia coli bacteria and highly purified, was introduced into aortocoronary bypass surgery as an additional therapeutic agent. A double-blind study was carried out on 40 patients with coronary heart disease, separated into "growth factor" and control groups, each containing 20 members. All patients were treated for coronary three-vessel vascular disease, in each case with an IMA bypass for the LAD and single venous bypasses for the RCX and or RCA. To bridge over additional peripheral stenoses in the LAD or one of its branches, human growth factor FGF was injected into the myocardium of those in the growth factor group. Twelve weeks later, the IMA bypasses were selectively demonstrated by intraarterial DSA. These angiographs were then quantitatively evaluated. In all patients of the growth factor group, the formation of new vessels could be demonstrated in the region where FGF had been administered in a manner strictly reminiscent of our experimental results. A capillary net sprouting from the coronary artery and making further connection with this vessel could be demonstrated, and the computer-supported evaluation of the angiographs showed a significant increase in the blood supply of the region of the myocardium injected. The use of FGF may be the appropriate treatment for patients with peripheral stenosis or diffuse coronary arteriosclerosis who cannot be treated surgically. However, large randomized studies are required to confirm these results.