First Experience With the Coronary Sinus Reducer System for the Management of Refractory Angina in Patients Without Obstructive Coronary Artery Disease

Giannini, Francesco; Baldetti, Luca; Ielasi, Alfonso; Ruparelia, Neil; Ponticelli, Francesco; Latib, Azeem; Mitomo, Satoru; Esposito, Antonio; Palmisano, Anna; Chieffo, Alaide; Colombo, Antonio

doi:10.1016/j.jcin.2017.06.062

Cited by 37 publications

(29 citation statements)

References 5 publications

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“…The CS reducer device was also shown to provide benefit in patients with refractory angina despite complete revascularization of the epicardial coronary arteries . Specifically, data from eight patients showed a significant reduction in CCS score, improvement in most of the domains of the Seattle Angina Questionnaire (physical limitation, angina stability, angina frequency, treatment satisfaction, and quality of life) and in 6‐min‐walk test .…”

Section: Resultsmentioning

confidence: 98%

“…A total of six studies involving 196 patients (mean age: 67.9 years, 81% men) were included in the systematic review (Figure ). NOS analysis showed that none of the included studies was classified as a poor‐quality study.…”

Section: Resultsmentioning

confidence: 99%

“…Data about the impact of CS reducer device on Seattle Angina Questionnaire domains are provided in Table . Moreover, implantation of the CS reducer device reduced the need for antianginal medications …”

Section: Resultsmentioning

confidence: 99%

See 2 more Smart Citations

The efficacy of coronary sinus reducer in patients with refractory angina—A systematic review of the literature

Bazoukis

Brilakis

Tse

et al. 2018

J Interven Cardiology

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Section: Resultsmentioning

confidence: 98%

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

The efficacy of coronary sinus reducer in patients with refractory angina—A systematic review of the literature

Bazoukis

Brilakis

Tse

et al. 2018

J Interven Cardiology

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“…As consequence of the maneuver, a distal deformation ("partial Although, evidence on CS Reducer safety is limited to some observational studies [3][4][5][6] and to the COSIRA trial 2 , initial experience shows rare periprocedural or device-related complications. Since the first CS Reducer implantation on 2004, only a case of CS perforation has been reported so far.…”

Section: Case Reportmentioning

confidence: 99%

“…The consequent increase of CS and backward pressures of the coronary tree should promote a redistribution of the blood flow toward more ischemic myocardial territories, thus improving ischemia and symptoms. A single randomized, sham‐controlled trial and few observational studies have demonstrated its safety and efficacy. The initial promising results, with associated reduction of both angina symptoms and myocardial ischemia burden might lead to increased future Reducer implantations; therefore, experience on how to manage potential complications that might arise would be of clinical significance.…”

Section: Introductionmentioning

confidence: 99%

Percutaneous management of periprocedural coronary sinus Reducer migration

Tzanis

Durante

Mitomo

et al. 2018

Cathet Cardio Intervent

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Coronary Venous Pressure and Microvascular Hemodynamics in Patients With Microvascular Angina

Ullrich,

Hammer,

Olschewski

et al. 2023

JAMA Cardiol

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ImportanceThe role of the coronary venous circulation in regulating myocardial perfusion and its potential in treating microvascular angina is unexplored.ObjectiveTo evaluate whether an increase in coronary venous pressure modifies microvascular resistance in patients with microvascular angina.Design, Setting, and ParticipantsThis was a blinded, sham-controlled, crossover, randomized clinical trial that enrolled participants between November 2021 and January 2023. Participants for this physiology end point study were recruited from the Cardiology Center of the University of Medicine in Mainz, Germany. Patients with moderate/severe angina pectoris (Canadian Cardiovascular Society class 2-4) due to microvascular dysfunction (as defined by the thermodilution-based index of microvascular resistance &gt;25 mm Hg × s). Exclusion criteria were epicardial coronary disease, second- and third-degree atrioventricular block, severe valvular heart disease, cardiomyopathy, and pulmonary or kidney disease.InterventionInflation of an undersized balloon placed in the cardiac coronary sinus (CS), hereafter referred to as balloon and with the deflated balloon in the right atrium, referred to as sham. Measurements were performed at rest and during maximal coronary hyperemia. Both patients and final assessors were blinded to the randomization sequence.Main Outcomes and MeasuresHemodynamic parameters, including aortic (Pa) and distal (Pd) coronary pressure, coronary sinus pressure (Pcs), right atrial pressure (Pra), and the mean transit time (inverse of blood flow [Tmn]), were measured.ResultsA total of 20 patients (median [IQR] age, 69 [64-75] years; 11 female [55.0%]) were included in the study. Two patients (10%) had diabetes, 6 (30%) had hypercholesterolemia, 15 (75%) had hypertension, and 3 (15%) were active smokers. The inflation of the CS balloon caused a significant increase in CS pressure at rest and during hyperemia (300% and 317% increase, respectively, compared with sham, both P &lt; .001), a decrease in hyperemic distal coronary pressure (median [IQR], sham: 98 [88-110] mm Hg; balloon: 89 [84-102] mm Hg; P = .01) and median (IQR) transit time (sham: 0.39 [0.23-0.62] s; balloon: 0.26 [0.17-0.46] s; P &lt; .001). As a result, CS occlusion led to a decrease in both resting coronary resistance (median [IQR], sham: 59 [37-87] mm Hg × s; balloon: 42 [31-67] mm Hg × s; P = .005) and the primary end point hyperemic coronary resistance (mean [IQR], sham: 31 [23-53] mm Hg × s; balloon: 14 [8-26] mm Hg × s; P &lt; .001).Conclusion and RelevanceIncreased coronary venous pressure led to a reduction of microvascular resistances in patients with microvascular angina, a mechanism with potential implications for the therapy of this complex disease.Trial RegistrationClinicalTrials.gov Identifier: NCT05034224

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First Experience With the Coronary Sinus Reducer System for the Management of Refractory Angina in Patients Without Obstructive Coronary Artery Disease

Cited by 37 publications

References 5 publications

The efficacy of coronary sinus reducer in patients with refractory angina—A systematic review of the literature

The efficacy of coronary sinus reducer in patients with refractory angina—A systematic review of the literature

Percutaneous management of periprocedural coronary sinus Reducer migration

Coronary Venous Pressure and Microvascular Hemodynamics in Patients With Microvascular Angina

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