Contemporary challenges and percutaneous cardiac interventions for patients with refractory angina

Abstract

Refractory angina pectoris is a chronic disabling condition affecting a growing number of patients (10-15%) with ischemic heart disease. It is defined as debilitating anginal complaints despite optimal medical therapy due to severe and/or diffuse coronary artery disease (CAD) without options for percutaneous or surgical revascularization procedures. Patients with refractory angina have a reduced life expectancy and represent the most fragile population among those with chronic ischemic heart disease.In this thesis, we sought to explore the role of percutaneous cardiac interventions in the treatment of patients with refractory angina. We will indeed not only describe the available approaches in this setting, but we will study how recent developments and improvements in materials, techniques and devices allow for a more efficient and less invasive approach. This doctoral dissertation is divided into two major chapters. The first one (PART-I) will centre on the evolution of percutaneous coronary intervention (PCI) in chronic total occlusions (CTO) and will comprise different aspects of CTO-PCI optimization. Furthermore, a novel approach to CTO-PCI (namely the Minimalistic Hybrid Approach) is described, aiming at reducing the use of large bore guiding catheters, limiting the dual vascular access and favouring a trans-radial approach over a femoral approach. The second major chapter of this dissertation (PART-II) is dedicated to a recently introduced device for the treatment of refractory angina, namely the Coronary Sinus Reducer (CSR). After a general overview on the device characteristics, indications and mechanisms of action, we will provide new insights on the physiological consequences of CSR implantation and its efficacy in various clinical settings