Coronary Sinus Reducer Device for Patients with Refractory Angina
Abstract
Introduction
Description of the case
Patient history
Stepwise description of the implantation of the device
Postinterventional course
Discussion
The subendocardial microvasculature and its contribution overall
Prevalence of refractory angina in patients withcoronary artery disease
Limitations of PCI and CABG in this patient population and currently available medications to improve this
Mechanistic approach of the coronary sinus reducer and current indications
- Elevation of the coronary sinus pressure increases the back pressure in the precapillary arteriolar system and thereby enhances the dilatation of the constricted subendocardial capillaries, which shifts coronary flow from the subepicardium to the subendocardium.
- Coronary blood flow and myocardial contractility decrease in the infarcted myocardium, resulting in decreased regional perfusion pressure. When the coronary sinus pressure rises, this promotes a shift in blood flow within pre-existing collaterals from nonischaemic (high tissue pressure) to ischaemic (low tissue pressure) myocardium, specifically reducing subendocardial ischaemia [23]. This effect was observed with and without intact vasomotor tone, the later being induced by adenosine infusion [24].
- Since the subendocardium is at significantly higher risk of ischaemia, coronary sinus occlusion reverses the subendocardial to epicardial blood flow ratio towards the subendocardium. In addition, early studies in pigs demonstrated that full occlusion or permanent constriction of the coronary sinus leads to neovascularisation (development of new collaterals) within the epicardial and intramyocardial layers of the heart.
Ongoing studies
Conclusion
Disclosure statement
References
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Kahr, P.C.; Giannopoulos, A.A.; Buechel, R.R.; Gaemperli, O.; Banai, S.; Obeid, S.; Lüscher, T.F. Coronary Sinus Reducer Device for Patients with Refractory Angina. Cardiovasc. Med. 2018, 21, 105. https://doi.org/10.4414/cvm.2018.00553
Kahr PC, Giannopoulos AA, Buechel RR, Gaemperli O, Banai S, Obeid S, Lüscher TF. Coronary Sinus Reducer Device for Patients with Refractory Angina. Cardiovascular Medicine. 2018; 21(4):105. https://doi.org/10.4414/cvm.2018.00553
Chicago/Turabian StyleKahr, Peter C., Andreas A. Giannopoulos, Ronny R. Buechel, Oliver Gaemperli, Shmuel Banai, Slayman Obeid, and Thomas F. Lüscher. 2018. "Coronary Sinus Reducer Device for Patients with Refractory Angina" Cardiovascular Medicine 21, no. 4: 105. https://doi.org/10.4414/cvm.2018.00553
APA StyleKahr, P. C., Giannopoulos, A. A., Buechel, R. R., Gaemperli, O., Banai, S., Obeid, S., & Lüscher, T. F. (2018). Coronary Sinus Reducer Device for Patients with Refractory Angina. Cardiovascular Medicine, 21(4), 105. https://doi.org/10.4414/cvm.2018.00553