HartCentrum, Ziekenhuis Netwerk Antwerpen (ZNA) Middelheim, Antwerp, Belgium.
Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy.
Curr Cardiol Rep. 2021 Mar 2;23(4):31. doi: 10.1007/s11886-021-01463-w.
The prevalence of angina despite optimal medical therapy is high among patients with coronary chronic total occlusions. Despite advancements in techniques and operator's experience, percutaneous revascularization of coronary chronic total occlusions is still associated with a not negligible risk of failures and complications. The Coronary Sinus Reducer, a new device developed to improve angina, has shown promising results in terms of efficacy and safety in patients with refractory symptoms. The aim of this review is to summarize the evidence so far available and to guide clinicians in the selection of patients with chronic total occlusions that could benefit more from Coronary Sinus Reducer implantation.
A recently published study suggests a clear value of this device in patients with chronic total occlusions. This is likely to be related to the presence of a well-developed collateral circulation. A careful evaluation of risks and benefits of both myocardial revascularization and Coronary Sinus Reducer implantation should be done in all the cases in order to better define the optimal strategy for the patient. The Coronary Sinus Reducer implantation has a rationale in patients with chronic total occlusion as an alternative or additional therapy to myocardial revascularization.
尽管采用了最佳的药物治疗，仍有相当比例的冠心病慢性完全闭塞患者存在心绞痛。尽管技术和术者经验有所进步，但经皮冠状动脉慢性完全闭塞血运重建仍然存在不可忽视的失败和并发症风险。冠状动脉窦减容器是一种新开发的用于改善心绞痛的装置，在难治性症状患者中显示出良好的疗效和安全性。本综述旨在总结现有证据，并指导临床医生选择可能从冠状动脉窦减容器植入中获益更多的慢性完全闭塞患者。
最近发表的一项研究表明，该装置在慢性完全闭塞患者中有明确的应用价值。这可能与良好发育的侧支循环有关。为了更好地确定患者的最佳策略，应仔细评估心肌血运重建和冠状动脉窦减容器植入的风险和获益。对于慢性完全闭塞患者，冠状动脉窦减容器植入具有一定的合理性，可作为心肌血运重建的替代或附加治疗。
