A Novel Micro-Angiography Detecting Angiogenesis, Application for Autologous Bone Marrow Mononuclear Cells Transplantation in the Patients with Critical Limb Ischemia

Summary

Conventional Anigiographic Findings in Autologous Bone Marrow Mononuclear Cells Transplantation for Critical Limb Ischemia: Bone marrow mononuclear cells have many of the characteristics of stem cells for mesenchymal tissues, and secrete many angiogenic cytokines. We performed autologous transplantation of bone marrow mononuclear cells in six patients with critical limb ischemia due to Buerger disease, who were not candidates for catheter or surgical revascularization. Leg pains at rest and skin ulcers improved after bone marrow transplantation in all patients, although significant collateral developments after the therapy by conventional angiography could not be observed. Autologous transplantation of bone marrow mononuclear cells including stem cells improved critical limb ischemia due to Buerger disease. Neovascularization after therapeutic angiogenesis might be quite small and could not be visualized by conventional angiography.

Novel Micro-angiograpy: We developed in-hospital micro-angiographic equipment which consisted of a high power X-ray source for computed tomography and an avalanche type detector characterized by a high spatial resolution (20 µm) and high sensitivity (100 times of CCD camera). We visualized mid-zone collaterals after femoral arterial exfoliation with and without therapeutic angiogenesis in rabbit ischemic limbs and assessed the radio-absorptions in a clinical setting. The micro-angiography clearly demonstrated mid-zone collaterals after the treatment with a diameter of down to 50µm, but the conventional angiography did not. The sum of radio-absorptions for 10 seconds in clinical settings was 300 mSv. The newly developed in-house micro-angiography could illuminate micro-vessels with a diameter of down to 50µm in clinical settings safely and could be useful in the evaluation of therapeutic angiogenesis.