Coronary Sinus Reducer
What is refractory angina?
Angina is heart pain that is caused by narrowing in the (arteries) blood vessels of the heart. These are like fuel pipes that get blood containing oxygen to the heart muscle, and when not enough gets through the heart will feel pain.
Refractory angina occurs when the usual treatments of medicines, stents and coronary artery bypass grafts haven’t worked to get the symptoms under control. There are a number of reasons why this can occur and cardiologists often have to work to understand the problem. Amongst others the issues could be:
- narrowing that aren’t able to be treated with stents or bypass grafts
- narrowing or dysfunction in the small blood vessels of the heart (called microvascular angina)
- narrowing caused by spasm of the blood vessels (called vasospastic angina)
- non heart chest pain (caused by muscles, bones, joints, lungs, stomach, nerves or oesophagus) – this can sometimes be the case even when it’s previously been diagnosed as angina
It’s the job of a cardiologist to figure why the angina remains and try to make a plan to best deal with it. By it’s nature refractory angina is really tricky to treat, and improvements are hard to come by.
What is a Coronary Sinus Reducer?
A Coronary Sinus Reducer is a relatively new device that has been engineered to help treat refractory angina. It is an hourglass shaped stent that sits in the main vein of the heart (unlike other heart stents that go in the arteries). It’s job is to slow the flow of blood out of the heart muscle.
It’s a bit like an old cartoon where the character steps on a hosepipe and all the water backs up behind. The stent is put in using the same techniques as ordinary stents although normally via the neck rather than the wrist or groin.
How can a Coronary Sinus Reducer help?
The device has been shown to reduce symptoms in patients with refractory angina in a number of clinical trials. The criteria for the device is quite strict so patients will usually need scan before we’re sure it will help. This might include a treadmill test or an MRI scan. It also may require a repeat angiogram.
Sometimes the Coronary Sinus Reducer is one of several options available, and different medications, or a more complex stent procedure (even if colleagues have said it’s not an option) is a better choice.
There is a chance that it may not help your angina, and we don’t want patients to have an invasive procedure that won’t help them. All procedures have risks attached to them and there is always a careful consent taken before undertaking this procedure.