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Coronary Sinus Reducer Device — EECC MCQ

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ModerateCoronary Artery DiseaseCoronary Sinus Reducer DeviceEECC

A 65-year-old man with chronic stable angina on maximal medical therapy and diffuse non-revascularisable CAD reports that his angina significantly limits his daily activities. His CCS angina class is III. He asks about the coronary sinus reducer device. What is it?

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Correct answer: C — The coronary sinus reducer is an hourglass-shaped stainless steel device implanted percutaneously in the coronary sinus that creates a controlled stenosis, raising coronary sinus pressure and redistributing blood flow from the epicardium to the ischaemic subendocardium — Class IIb for refractory angina

The coronary sinus reducer (Neovasc Reducer) is implanted percutaneously (via jugular or femoral venous access) into the coronary sinus. Its hourglass shape creates a controlled narrowing that elevates coronary venous pressure. This: (1) raises subendocardial perfusion pressure (the subendocardium, being most vulnerable to ischaemia, receives increased blood flow when coronary venous pressure rises); (2) redistributes myocardial blood flow from non-ischaemic epicardium to ischaemic subendocardium; (3) promotes neovascularisation. The COSIRA trial (sham-controlled) demonstrated significant improvement in CCS angina class and exercise capacity. The 2024 ESC CCS Guidelines include the coronary sinus reducer as a Class IIb recommendation for refractory angina in patients with documented ischaemia who are not candidates for conventional revascularisation.

Reference: ESC (2024): CCS Guidelines; COSIRA Trial