Percutaneous treatment of refractory angina

Patients on optimal medical therapy who continue to experience angina despite the absence of revascularization targets and with evidence of inducible ischemia on a functional test, may benefit from Reducer implantation. The Reducer is an hourglass-shaped stainless steel device mounted on an expandable balloon, which is implanted percutaneously into the coronary sinus. Such a device creates a reduction in coronary sinus caliber that leads to an increase in pressure in the heart's venous system, allowing a balance between subepicardial and subendocardial flow. Several studies have shown that implantation of this device correlates with improved angina symptoms and reduced ischemia.

The procedure is performed under local anesthesia, from a jugular venous access, and consists of cannulation of the coronary sinus (which is opacified by injecting contrast medium) and release of the device within it.