Percutaneous Device to Narrow the Coronary Sinus: Shifting Paradigm in the Treatment of Refractory Angina? A Review of the Literature.

Daniela Benedetto,Pieter R Stella,Friso Kortlandt,Freek Nijhoff,Pierfrancesco Agostoni,Pieter A Doevendans,Maxime D M Lakemeier,Masieh Abawi

doi:10.3389/fcvm.2016.00042

Abstract

Refractory angina pectoris is defined as a chronic debilitating condition characterized by the presence of chronic anginal symptoms due to a severe obstructive and/or diffuse coronary artery disease that cannot be controlled by the combination of medical therapy and/or revascularization (percutaneous or surgical). In addition, the presence of myocardial ischemia as a cause of the symptoms must have been documented. The coronary sinus reducer (CSR) is a recently introduced percutaneous device to treat patients with severe anginal symptoms refractory to optimal medical therapy and not amenable to conventional revascularization. The purpose of this review is to describe the current evidence from available studies measuring the clinical effect of the CSR implantation on the health and well-being of patients with refractory angina.

Highlights

Refractory angina pectoris is defined as a chronic debilitating condition characterized by the presence of anginal symptoms due to a severe obstructive and/or diffuse coronary artery disease (CAD) that cannot be controlled by the combination of medical therapy and/or revascularization.Despite the numerous methods of treatment of CAD, a growing number of patients (10–15%) with severe chronic ischemic heart disease continue to have refractory angina not susceptible to therapeutic alternatives [1]
Patients with refractory angina use many anti-ischemic medications, experience impaired quality of life because of debilitating symptoms, and are relatively young (60–65 years) [10]. These results indicate the need for new therapies targeting the reduction of symptoms in this population, taking into account the potential impact in terms of health-care consumption and cost [6]
The coronary sinus reducer (CSR) is an endoluminal device, which consists of a stainless steel stent in the shape of an hourglass mounted on an expandable balloon with the same shape once inflated (Figure 1)

Summary

INTRODUCTION

Refractory angina pectoris is defined as a chronic debilitating condition characterized by the presence of anginal symptoms due to a severe obstructive and/or diffuse coronary artery disease (CAD) that cannot be controlled by the combination of medical therapy and/or revascularization (percutaneous or surgical). The factors responsible for the heterogeneity of these patients are the severity and frequency of angina [measured with the class of angina of the Canadian Cardiovascular Society (CCS)], the extent of CAD, the presence of recurrent coronary restenosis after percutaneous treatment, the presence of an occluded bypass graft in post-coronary artery bypass graft (CABG) surgery patients, and the presence of coronary chronic total occlusions. These may explain the difficulties encountered in assessing the effectiveness and mechanisms of action of various proposed therapeutic alternatives [4,5,6]. Beck-II procedure has little in common with the CSR as the first is a surgical operation, the second is a percutaneous intervention; the concept of narrowing the CS is similar, and this makes the two procedures conceptually comparable (interestingly both procedures aim at a residual lumen diameter in the CS around 3 mm)

DEVICE AND IMPLANTATION PROCEDURE

SAFETY AND EFFICACY PERFORMANCES

MECHANISM OF ACTION

Findings

THE CS REDUCER AS A TREATMENT OPTION FOR REFRACTORY ANGINA