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These techniques, which have been partially translated from animal experiments to clinical practice, have been demonstrated to be more efficient than systemic or arterial injection (into a severly stenosed vasculature). Nevertheless, potential pitfalls such as extensive inhomgene distribution of therapeutic agent in the ventricular wall of the heart, have been diminished by using the NOGA system [3] or selective retroinfusion [4]. With the use of retroinfusion, the limitation of an impaired arterial perfusion is circumvented by utilization of the venous drainage system, which parallels the arterial perfusion pattern in the case of the large coronary arteries as well as the femoral arteries. This vessel compartment is not prone to develop atherosclerosis and allows for retroinfusion with only modest perfusion pressures (e.g. 20mmHg above the individual venous occlusion pressure). However, it implies several anatomic and functional details, which are crucial for a safe and efficient utilization of the retrograde approach to an ischemic tissue.

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