Schematic of percutaneous myocardial revascularization

Percutaneous myocardial revascularization can be performed in the catheterization laboratory, via standard femoral artery access without general anesthesia, after a ventriculogram and coronary angiogram demonstrate the left ventricular and coroanry artery anatomy. A steerable catheter is delivered retrograde across the aortic valve; the energy delivery catheter is advanced through the guiding catheter and placed in the ventricular chamber. The steerable catheter allows access to the endocardial surface (left panel). The enlarged area (right panel) shows that intramyocardial channels are made by tissue ablation (red arrow) when the energy delivery catheter is in contact with the endocardium; the channels cause intramyocardial hemorrhage by transecting the microvasculature (blue arrow).