Anyone had a coronary sinus reducer?

[SomersetJo]

I haven't been on here in a long while. My medical history is pretty complex, I'm seen locally at the Bristol Heart Institute but also under the care of the Cardio-oncology team at the Royal Brompton which a forum member told me about years ago thankfully. Basically my bone marrow transplant and other treatment for leukaemia has likely caused my heart disease.

Since 2019 I have had 5 angiograms and 3 angioplasties. I'm urgently awaiting another one of each. Apparently I have atypical disease which is described as aggressive, progressive or accelerating (depending on which letter I'm reading.). My stents block up again very quickly despite being drug eluting ones. Recently we have had some conversations about the pros and cons of stenting or bypass. At a recent multi team meeting a coronary sinus reducer has been mentioned. From what I have read, it's a more 'novel' approach, but I can understand why my team are suggesting it. I'm just wondering if anyone else knows much about it or has had one please?

[BeKind28-]

Hello

You are going through such a lot I have the a lot of respect for you dealing with all this

I have not heard of what they are suggesting but I would put my faith in them as I am sure they will want what is best for you

Let us know how you get on x

[SomersetJo in reply to BeKind28-]

Thank you for your good wishes. Jx

[BeKind28- in reply to SomersetJo]

x

[Milkfairy Heart Star]

Hello

SomersetJo,

Coronary sinus reducers are an experimental treatment for refractory angina.

They seem to reduce the severity and frequency of angina for some people, however overtime they may become less effective.

The coronary sinus reducer will not be able to open up your blocked coronary arteries.

It is a special stent that is placed in the coronary sinus were the blood flows to from the heart. The theory is, the reducer slows the flow of the blood from the heart, allowing it to pool in the heart muscle and helps to oxygenated the heart muscle further.

This is how it is thought to reduce the symptoms of angina

The NICE guidelines suggests that they should not be used routinely and patients should under go a full psychological assessment before they are used.

nice.org.uk/guidance/ipg712...

Only a few small trials have taken place to see if they are safe or effective. Most of the participants were men.

There are a few very small trails taking place on whether coronary sinus reducers may help people living with microvascular dysfunction

Have you been offered any tests to determine whether you have microvascular dysfunction as well as obstructive coronary artery disease?

It is possible to have both.

Microvascular dysfunction can be caused by some cancer treatments.

I live with vasospastic angina which can only be treated by medication which I don't respond well to either.

My angina will become unstable from time to time and I end up in hospital for treatment with IV GTN about once or twice a year, for about a week.

My very experienced Cardiologist says I am rare and says that I have an unusually severe aggressive type of vasospastic angina.

So no stents or surgery will ' fix' me.

I have had to find other ways to help manage my symptoms.

I found attending a Pain Management Programme helpfull, having support from a Clinical Psychologist and Physiotherapist.

I also use a Transcutaneous electrical nerve stimulation TENS machine too.

I hope you are able to make the decision which is the best one for you, which will improve the quality of your life.

I suggest you seek several Cardiologists' opinions before making any decisions.

Here's some further information about coronary sinus reducers which you may find helpful.

rbht.nhs.uk/our-services/he....

onlinelibrary.wiley.com/doi...

academic.oup.com/ehjcr/arti...

I wish you the best of luck.

[SomersetJo in reply to Milkfairy]

Hi again Milkfairy, you were the lovely person who told me about the cardio-oncology team at the Brompton I believe, for which I am forever thankful. I couldn't quite remember your name

Thanks for all the info. Yes, I'm gathering it's a newish approach, but I can understand their rationale as I do have both types of angina (microvascular obstructive CAD) and heart disease. The angina is really unstable at the moment - I was in hospital recently over 2 weeks with it. In this last week I have had the PET scan with Rubidium and an MRI stress test to help the Bristol team plan the angioplasty I'm currently waiting for.

I'm encouraged to hear that even with all the unusual things you have going on, you are still here and have found ways of managing things. Thanks so much for your reply.

[Milkfairy Heart Star in reply to SomersetJo]

Thank you for your kind words.

I am so sorry you are facing further problems.

Life is so unfair at times!

I spent 16 days in hospital once on IV GTN, so I appreciate how challenging your recent two week stay in hospital could be.

Do say how you get on.

Send me a message if you wish.

[Hun084]

Hi Somersetjo,I hope you are keeping well.

Did you go ahead and have this treatment?

I'm due to have this in April. A very short history about me I've had 3 Heart Attacks, 9 angiograms and 3 stents. Angina when walking, effecting my daily routines etc.

Any feedback is much appreciated. X