Interventional Cardiology Unit, GVM Care & Research Maria Cecilia Hospital, Via Madonna di Genova, 1, 48033 Cotignola RA, Italy.
J Invasive Cardiol. 2021 Nov;33(11):E884-E889. doi: 10.25270/jic/22.00643. Epub 2021 Sep 17.
Refractory angina affects an increasing proportion of the population with advanced coronary artery disease and microvascular dysfunction. Limited effective pharmacological and interventional therapies exist for this patient cohort. The coronary sinus (CS) reducer, recently recommended in the 2019 guidelines of the European Society of Cardiology for the management of chronic refractory angina, is a balloon-expandable, stainless-steel device designed for implantation in the CS. It acts by increasing CS pressure, thereby redistributing blood to ischemic myocardium, relieving symptoms, and improving quality of life. However, between 15%-30% of patients do not respond to this treatment. Six mechanisms appear to explain this poor response to CS reducer therapy: (1) inappropriate patient selection; (2) cardiac venous system heterogeneity; (3) CS size; (4) incomplete device endothelialization; (5) coronary artery disease phenotype and progression; and (6) limited myocardial ischemia at baseline. We hereby review these mechanisms in detail and highlight key areas that should be addressed in order to try and reduce the burden of non-responders following CS reducer implantation.
难治性心绞痛影响越来越多患有晚期冠状动脉疾病和微血管功能障碍的人群。对于这一患者群体，目前有限的有效药物和介入治疗方法。冠状动脉窦（CS）减少器，最近在 2019 年欧洲心脏病学会指南中被推荐用于治疗慢性难治性心绞痛，是一种球囊扩张的不锈钢装置，设计用于植入 CS。它通过增加 CS 压力，从而将血液重新分配到缺血心肌，缓解症状，提高生活质量。然而，15%-30%的患者对这种治疗没有反应。有六种机制似乎可以解释对 CS 减少器治疗的这种不良反应：（1）患者选择不当；（2）心静脉系统异质性；（3）CS 大小；（4）不完全的装置内皮化；（5）冠状动脉疾病表型和进展；以及（6）基线时的心肌缺血有限。我们在此详细回顾这些机制，并强调应该解决的关键领域，以尽量减少 CS 减少器植入后无反应者的负担。
