Devices for refractory angina treatment

Introduction

In cath lab everyday practice, the interventionist is increasingly facing patients with disabling symptoms despite optimal medical therapy for whom revascularisation is not an option because of unsuitable coronary anatomy, risk-benefit considerations contraindicating the procedure or lack of target lesions. This growing population has often been described as having refractory angina (RA) 1.

FOCUS BOX 1Features of refractory angina Definition: a chronic condition caused by clinically established reversible myocardial ischaemia in the presence of coronary artery disease, which cannot be adequately controlled by a combination of medical therapy, angioplasty or coronary artery bypass graft Epidemiology: (estimated) 5-10% of patients with stable coronary artery disease, possibly accounting for 50,000-100,000 new cases/year in the USA and 30,000-50,000 new cases/year in Europe Prognosis: modest mortality of 3.9% at one year and high long-term survival rate (77.6% at nine years) Emerging non-pharmacological treatment options: (a) addressing myocardial perfusion: Coronary Sinus Reducer device, enhanced external counterpulsation, extracorporeal shockwave therapy, cell therapy through percutaneous injection/transfusion. (b)...