Relief for chronic angina: Insights on the coronary sinus reducer

If you suffer from chronic angina, a condition marked by severe chest pain due to reduced blood flow to the heart, you might be a candidate for a procedure involving a coronary sinus reducer. This relatively new medical device offers a therapeutic option for those whose symptoms persist despite medications and when other treatments (as stents or coronary bypass surgery) have failed or are technically unfeasible. In his latest online article, Dr Giovanni Luigi De Maria gives us his insights.

What is a coronary sinus reducer?

A coronary sinus reducer is a small, hourglass-shaped device implanted into the coronary sinus, a large vein in the heart that collects deoxygenated blood. The purpose of this device is to create a controlled narrowing in the vein, which helps to redistribute blood flow within the heart redirecting oxygen   towards those regions affected by an impaired supply. This process can alleviate the symptoms of angina, providing relief for patients who have not responded to other treatments.

How does the procedure work?

The procedure to implant a coronary sinus reducer is minimally invasive. It is typically performed under local anaesthesia, which means you will be awake but your chest area will be numbed to prevent pain. After a very small incision is made on the right side of neck, and a catheter (a thin, flexible tube) is inserted into the jugular vein. The catheter is guided to the coronary sinus, where the reducer is then placed. The entire procedure usually takes less than an hour, and typically patients can go home the same day after a few hours of monitoring in hospital.

Who is a candidate?

This treatment is primarily for patients with refractory angina, which is angina (typically during physical activities – either strenuous or mild) that does not respond to standard treatments like medications or heart procedures such as angioplasty/stenting or coronary artery bypass grafting. If you have been experiencing persistent chest pain despite these measures, you might be a good candidate for a coronary sinus reducer. Your cardiologist will assess your specific condition and medical history to determine if this option is suitable for you.

Benefits and risks

The main benefit of the coronary sinus reducer is the significant reduction in angina symptoms, which can greatly improve quality of life. Many patients report being able to perform daily activities with less pain and discomfort. Like any medical procedure, there are associated risks. These may include bleeding, infection, or an adverse reaction to the anaesthesia. However, complications are rare, and the procedure is considered safe for most patients. The risk of coronary sinus reducer implant is definitely lower when it is compared with risk associated with first-line heart procedure to treat angina as coronary stenting or cardiac surgery with bypass.

Aftercare and recovery

Following the implantation, you will need to take it easy for a few days, avoiding strenuous activities. Your doctor will provide specific aftercare instructions and schedule follow-up appointments to monitor your progress.

The response to the treatment is not immediate as the device elicits its effects on symptoms after a few weeks/months. Typically, a follow up visit is arranged within 6 months to establish whether there has been a response and whether medications to control chest pain can be reduced (and sometimes discontinued).

It's important to adhere to any prescribed medication and to report any unusual symptoms to your healthcare provider immediately.

Dr Giovanni Luigi De Maria is an esteemed consultant interventional cardiologist. You can schedule an appointment with Dr De Maria on his Top Doctors profile.