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(Circulation. 2003;108:2613.)
© 2003 American Heart Association, Inc.

Clinician Update

Clinician Guide to Angiogenesis

Neil P. Fam, MD, MSc; Subodh Verma, MD, PhD; Michael Kutryk, MD, PhD; Duncan J. Stewart, MD

From the Division of Cardiology, St. Michael’s Hospital, The University of Toronto (N.P.F., M.K., D.J.S.), and the Division of Cardiac Surgery, Toronto General Hospital (S.V.), Toronto, Ontario, Canada.

Correspondence to Duncan J. Stewart, MD, St. Michael’s Hospital, 30 Bond St, Toronto, Ontario, Canada M5B 1W8. E-mail stewartd@smh.toronto.on.ca

An extract of the first 250 words of the full text is provided, because this article has no abstract.

	Introduction

 
Case Presentation: J.A. is a 63-year-old man with type II diabetes and hypercholesterolemia. He has suffered 2 previous myocardial infarctions and has chronic angina. Previous angiography showed diffuse 3-vessel coronary artery disease not amenable to conventional revascularization. What are the current concepts surrounding the use of therapeutic coronary angiogenesis in this setting?

Since recognition of the central role of angiogenic factors in tumor growth over 30 years ago,¹ physiological and pathological angiogenesis has been implicated in diverse conditions, including vascular insufficiency, inflammation, and diabetic retinopathy. Despite considerable advances in medical therapy and improvements in revascularization procedures for coronary artery disease, a substantial proportion of patients suffer from refractory angina or recurrent myocardial ischemia requiring hospitalization. In the past decade, a number of clinical trials have examined the role of therapeutic angiogenesis for myocardial ischemia. In this article, we focus on the fundamental mechanisms of angiogenesis and discuss current and future issues in therapeutic coronary angiogenesis.

	Principles of Angiogenesis

 
Three distinct mechanisms of new blood vessel formation have been identified: Vasculogenesis, angiogenesis, and arteriogenesis. Vasculogenesis refers to the formation of blood vessels from endothelial progenitor cells, a process that was initially described as occurring during embryonic development, and more recently, in adult animals.² Angiogenesis involves the sprouting of new capillaries from preexisting vessels, whereas arteriogenesis refers to remodeling of newly formed or preexisting vascular channels into larger and well-muscularized arterioles and collateral vessels.³ The generation of new vascular channels by angiogenesis and arteriogenesis has been shown in both animal models of myocardial ischemia . . . [Full Text of this Article]

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