What is the purpose of a coronary sinus reducer?

From the Guidelines

A coronary sinus reducer is used to ameliorate symptoms of debilitating angina refractory to optimal medical and revascularization strategies. The device works by creating a narrowing in the coronary sinus, which increases pressure in the venous system of the heart, promoting the growth of new blood vessels (collaterals) and improving blood flow to oxygen-deprived areas of the heart muscle 1.

Key Points

• The coronary sinus reducer is considered for patients with severe angina symptoms who have exhausted other treatment options, including medication, angioplasty, and bypass surgery.
• The potential benefits of the device include reduced angina symptoms, improved quality of life, and increased exercise tolerance.
• The procedure to implant a coronary sinus reducer is minimally invasive and typically performed under local anesthesia, with the entire process usually taking about an hour 1.

Clinical Considerations

• Patients considering this device should discuss the potential benefits and risks thoroughly with their cardiologist to determine if it's an appropriate treatment for their specific condition.
• As with any medical procedure, there are risks associated with the implantation of a coronary sinus reducer, including infection, bleeding, and device migration.
• The use of a coronary sinus reducer is supported by the 2019 ESC guidelines for the diagnosis and management of chronic coronary syndromes, which recommend considering the device for treatment of refractory angina 1.

From the Research

Purpose of a Coronary Sinus Reducer

The coronary sinus reducer is a device designed to manage patients with severe angina symptoms refractory to optimal medical therapy and not amenable to further revascularization 2. The purpose of this device is to reduce angina symptoms and improve quality of life in patients with refractory angina.

Key Findings

• The coronary sinus reducer has been shown to be safe and effective in reducing angina symptoms and improving quality of life in patients with refractory angina 2, 3.
• The device works by increasing venous pressure, leading to a dilatation of arterioles and reduced arterial vascular resistance in the sub-endocardium 3.
• Studies have demonstrated significant improvements in Canadian Cardiovascular Society (CCS) class and quality of life scores in patients treated with the coronary sinus reducer 2, 3.
• The device has been shown to be a simple, safe, and effective option for most patients with refractory angina, although approximately 30% of patients may not respond to treatment 3.

Clinical Applications

• The coronary sinus reducer is an emerging treatment option for patients with refractory angina, a growing and major healthcare problem affecting millions of patients with coronary artery disease worldwide 4, 5.
• The device may be considered for patients who have failed optimal medical therapy and revascularization, and who continue to experience chronic anginal symptoms 2, 5.
• Cardiac resynchronization therapy (CRT) is feasible in patients implanted with a coronary sinus reducer, although lead extraction after implantation may be associated with a high risk of complications 6.