Coronary Sinus Reducer for Refractory Angina – Summary.
Coronary Sinus Reducer for Refractory Angina – Summary.
Published online on 11 August 2025 in JACC–Interventional Cardiology
1. What is it?
The Coronary Sinus Reducer (CSR) is a small hourglass-shaped stent placed in the coronary sinus vein to raise pressure and improve blood flow in patients with refractory angina.
2. Study Overview:
• Meta-analysis of 16 studies (848 patients).
• Included 3 high-quality, double-blind, placebo-controlled randomized controlled trials (RCTs) and 13 observational, unblinded single-arm studies.
3. Safety:
• Implant success: ~98%.
• No deaths or strokes during the procedure.
• Rare complications: device migration (1.5%), cardiac tamponade, device embolization.
4. Benefits:
• Improved angina class, quality of life scores, and exercise time.
• Improvements were larger in uncontrolled studies than in placebo-controlled trials — suggesting the real benefit may be smaller than early reports.
5. Key Message for Clinicians:
• CSR appears safe and may help certain patients with refractory angina, but strong placebo-controlled evidence is still lacking.
• Ongoing COSIRA-II trial will provide clearer answers.
6. Approval Status:
• CE mark in Europe.
• Not FDA-approved in the U.S.
• The lowest reported cost for the
Coronary Sinus Reducer procedure in the Gulf region is approximately USD 12,000.
