Cardiac Sinus Reducer ?

[Frogman53]

Anyone on here had one of these fitted ? I may be in line for one and I'm wondering if anyone has undergone this procedure.

[Milkfairy Heart Star]

Hello,

A Coronary sinus reducer is a type of stent that is placed in a large vein where the blood flows from the heart. It isn't a widely used device as as there haven't been many large scale research studies to support it's use. Most studies only have fewer than 100 participants

A coronary sinus reducer is offered to people with refractory angina and microvascular angina.

It is not certain how it works. It may slow the drainage of blood from the heart nor is it known for how long the sinus reducer continues to help reduce the symptoms of angina.

It requires an angiogram to put the device into the coronary sinus. The vein can be damaged during the insertion of the coronary sinus reducer.

This recent study from Imperial College Healthcare has some more information.

imperial.nhs.uk/about-us/ne....

I live with a rarer type of refractory angina caused by coronary vasospasms. I was offered a coronary sinus reducer many years ago, but after doing some research I decided it wasn't the right device for me.

I sought out a Cardiologist who offered me a specialised angiogram which confirmed my diagnosis of vasospastic angina. Which I am glad I did as a coronary sinus is not thought to be useful for people living with vasospastic angina as the coronary sinus may make coronary vasospasms worse.

[Frogman9 in reply to Milkfairy]

Thanks for your reply I'm still waiting for an appointment with the interventional cardiologist.... Let's see what he comes up with.

[Milkfairy Heart Star in reply to Frogman9]

I hope the consultation goes well and you are able to make a shared decision about which is the best treatment for you.

[Frogman9 in reply to Milkfairy]

It's either Pci to RCA /CTO or cardiac sinus reducer.. Just have to wait.

[Milkfairy Heart Star in reply to Frogman9]

Ah the waiting is so difficult 😫

[Andy5S in reply to Milkfairy]

hello Milkfairy,

I was going to ask this very question that was posted here. I am also currently talking to some cardiologists in US that are doing research on this device and actively recruiting for the trial.

You say it could make vasospasms worse? Where did you hear that or see it? I am going through the investigation phase to determine eligibility but I have heard or read nothing about it potentially making this worse. However I can’t find anyone who has vasospasms that has had this device put in.

Edit: As anyone that has vasospasms wil understand…. The thought of it being worse makes you literally want to drop everything and run the opposite direction!!!

[Andy5S]

I’m in same process to determine if it makes sense. There are videos on YouTube of the procedure as well as a few testimonials of patient experience afterwards and improvements. However I’m not sure yet how effective it is for different scenarios like mine with vasospasms.

I have been told that improvement can be potentially 1 or 2 classes of angina. However I’m sure there is variation. Have to see as maybe I won’t qualify as there is a very specific set of criteria you must meet and many quick disqualifications.

[Milkfairy Heart Star in reply to Andy5S]

Hello,

Have you been given a confirmed diagnosis of vasospastic angina following a functional angiogram using acetylcholine?

Here in the UK there is a pilot study into using coronary sinus reducers to treat microvascular dysfunction.

People with Vasospastic angina, coronary vasospasms confirmed by a functional angiogram are excluded.

If you look at the exclusion criteria of the study you see this listed.

"Clinically or angiographically diagnosed coronary vasospasm"

clinicaltrials.gov/study/NC...

I contacted the Principal Investigator, Dr Ranil de Silva and he confirmed by email that any patient with vasospastic angina will be excluded from the trial as the reducer could make coronary vasospasms worse.

I have lived with vasospastic angina for over 10 years. Mine is usually severe according to my Cardiologist.

I absolutely get it about not doing anything to make your vasospasms worse.

I am incredibly careful about managing my triggers.

I am sorry you belong to the club nobody wants to join!

[Andy5S]

this is a different study and that is not an exclusion here:

clinicaltrials.gov/study/NC...

However I was very clear with them about my condition and was skeptical of my eligibility as I don’t see how I clearly fit but there does not seem to be exclusion yet. However they are still collecting my records and all the tests that I have been through with cath and diagnosis.

As to formal diagnosis with the test you mention. They don’t do that here and basically test for everything else to rule out. This is frustrating because how can one know it’s vasospasm versus microvascular angina/disease. I get angina at rest and totally random but can work out and do physical activity. (I have most my life) I don’t get shortness of breath and have no other obstruction or structural problems. (At least since my last round of testing a year or so back)

I have debated about further tests but they just diagnosed CVA based on test results and symptoms. For this study I would have to do another stress test and angiogram to make sure I don’t need anything else or there can’t be any other options. The crazy thing is when I asked them about results and people they have dealt with in terms of symptoms, they said….

“People tend to have 20-30 episodes a day and can go to one or two times daily needing to take nitro”. First I was floored that people can have angina that bad and that is absolute nightmare. I said at this point I am a few times a week but nowhere near that severe. So they said I may have better results and may not have to be randomized. This is one of the top hospitals in eastern United States in Boston Ma and top cardiologist running the program. However I don’t know how this will go yet and if I qualify. I certainly don’t want to do anything that could make anything worse but will talk with them and see.

Edit: I am going to mention the study you refer to as well as Dr with the fact that this was said to be potentially something they could make worse. I really appreciate the data greatly milkfairy. As I’m sure you well understand that when you think there may be a way to improve this thing , you really want to dig in and see.

[Milkfairy Heart Star in reply to Andy5S]

Can I message you with some more information ?

[Andy5S in reply to Milkfairy]

Absolutely!