冠状静脉窦缩窄装置:难治性心绞痛治疗新进展

Coronary Sinus Reducer System: A Promising Novel Therapy for Refractory Angina

近年来,在缺血性心脏病治疗方面,尽管药物及介入治疗取得了巨大进展;但是,仍然有越来越多的患者由于不适宜行冠状动脉血运重建治疗,尽管接受了最佳的药物治疗,但心绞痛症状仍反复发作。针对难治性心绞痛的治疗,尝试了许多新型的治疗措施,但是没有一项治疗措施公认有效且被广泛应用。目前针对难治性心绞痛主要是采用药物治疗并纠正相关危险因素。研究表明,增加冠状静脉窦压力使冠状动脉血流从相对不缺血的心外膜向相对缺血的心内膜流动,从而减轻心肌缺血,改善心绞痛症状。经皮、静脉于冠状静脉窦内植入一个可经球囊扩张沙漏状不锈钢网状装置,导致冠状静脉窦固定狭窄,从而增加冠状静脉窦压力,目前针对该装置的一系列临床试验表明,其可行性、安全性及有效性均不断得到证实,可能成为难治性心绞痛新的治疗选择。这篇综述将从难治性心绞痛的临床特征、流行病学、治疗方案及冠状静脉窦缩窄装置作为难治性心绞痛新型治疗措施的可行性、安全性及有效性等方面来阐述。

Although remarkable advances in medical and invasive therapies for the treatment of ischemic heart disease, an increasing number of patients with advanced coronary artery disease unsuitable for revascularization continue to suffer from angina pectoris despite optimal medical therapy. A considerable number of innovative therapeutic options for the treatment of chronic angina have been investigated over the years, however, none of these therapeutic options has become a standard of care, and none are widely utilized. Current treatment options for refractory angina focus on medical therapy and secondary risk factor modification. Interventions to create increased pressure in the coronary sinus may alleviate myocardial ischemia by forcing redistribution of coronary blood flow from the less ischemic subepicardium to the more ischemic subendoeardium, thus relieving symptoms of ischemia. Percutaneous, transveuous implantation of a balloon expandable, hourglass-shaped, stainless steel mesh in the coronary sinus to create a fixed focal narrowing and to increase backwards pressure, may serve as a new device based therapy destined for the treatment of refractory angina. In this review, we mainly describe the clinical entity of refractory angina pectoris, its epidemiology and available treatment options, and review the accumulating evidence regarding the feasibility, safety and efficacy of interventions to narrow the CS as a potential novel therapy for refractory angina.