Abstract
Background: Due to the aging population and increased survival of the patients with coronary artery disease, there is an increasing number of patients with debilitating angina refractory to optimal medical treatment who are not candidates for revascularization. In case of low ischemic load, the treatment of stable refractory angina is aimed at symptom reduction. There are several new treatment methods targeting myocardial ischemia available, including coronary sinus flow reducer (CFR) implantation. Case Report: We report a case of a patient suffering from CCS class IV angina despite optimal medical therapy, with further revascualrization options exhausted, who was successfully treated with coronary sinus flow reducer (CFR). Besides technical skill to reach ostium of coronary sinus, the most important technical tip is precise positioning of the CFR. The reduction of angina symptoms started after epithelisation of CFR frame, usually 6 - 7 weeks after implantation. At 6-month follow-up, the patient reported a marked reduction of angina symptoms, with CCS grade improving by three classes (from IV to I). At 10-month follow-up, the sustainment of CCS grade I angina symptoms was reported by the patient. Conclusions: We conclude that CFR can be safely and successfully implanted in patients suffering from refractory angina. Considerable improvements in CCS grade may be experienced in certain cases.
Highlights
Advancements in drug and device therapy, along with the aging population, have increased the life expectancy of the patients with coronary artery disease (CAD) [1]
Case Report: We report a case of a patient suffering from Canadian Cardiovasular Society (CCS) class IV angina despite optimal medical therapy, with further revascualrization options exhausted, who was successfully treated with coronary sinus flow reducer (CFR)
We conclude that CFR can be safely and successfully implanted in patients suffering from refractory angina
Summary
Advancements in drug and device therapy, along with the aging population, have increased the life expectancy of the patients with coronary artery disease (CAD) [1] This has resulted in the increased prevalence of those CAD patients who have chronic angina pectoris refractory to medical treatment and who are ineligible for further surgical or percutaneous revascularization [2] [3]. Our heart centre has been employing CFR in RA treatment since 2016 with overall results so far closely matching the COSIRA trial outcomes In this case report, we describe a patient with multiple coronary diseases, after CABG and unsuccessful PCI of CTO RCA. After CFR implantation he showed a sustained improvement of angina symptoms at 6- and 10-month follow-up, demonstrating the safety and
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