Insights Into Coronary Sinus Reducer Non-Responders

Francesco Ponticelli, Arif A. Khokhar, Stefano Albani, Georgios Tzanis, Francesco Gallo, Stefano Guarracini, Shmuel Banai, Antonio Colombo, Francesco Giannini

Research output: Contribution to journalArticlepeer-review

4 Scopus citations


BACKGROUND: 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.

Original languageEnglish
Pages (from-to)E884-E889
JournalJournal of Invasive Cardiology
Issue number11
StatePublished - 1 Nov 2021


  • chronic coronary disease
  • interventional cardiology
  • percutaneous coronary intervention
  • refractory angina


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