New way to ease pain of angina
IT SOUNDS utterly bizarre, but surgeons have discovered a new way to relieve the pain of previously untreatable angina – by blocking a major vein in the heart.
The condition, which affects millions, occurs when the circulation that supplies the heart muscle with blood is reduced by narrowed diseased arteries.
First-line treatment includes medication and surgery to insert stents – tiny expandable wire mesh tubes – into arteries around the heart to prop them open.
The procedure restores the circulation and relieves the symptoms of angina, which include sometimes debilitating chest pain usually triggered by exertion.
However, 5 to 10 percent of patients do not respond to these approaches or are ineligible due to other health complications, and they are said to have refractory angina.
Now, in a move described by one leading surgeon as counter-intuitive, a new kind of stainless-steel stent shaped like an hour-glass is being used to narrow the coronary sinus, the vein that transports blood from the heart to the lungs.
The narrowing causes smaller surrounding arteries to dilate, increasing blood flow elsewhere in heart and alleviating angina pain.
The Coronary Sinus Reducer system is now being offered to patients in British government hospitals and trials have demonstrated that the life-changing procedure can improve blood flow to the heart muscle, relieving symptoms in about 70 percent of refractory angina patients.
The implant is inserted via a tiny incision in the jugular vein in the neck, when a patient is sedated.
A fine plastic tube – a cannula – is threaded through the blood vessels until it reaches the coronary sinus vein at the back of the heart.
A guide wire, with the collapsed mesh implant on the end and a deflated balloon inside it, is then pushed through.
Once it is in the correct position, the balloon is used to inflate the ends, leaving a narrow middle section. The entire procedure takes about 20 minutes and patients go home the same day.
The stent remains in place and the blood vessel walls grow into and around the implant, leading to a narrowing of the vein.
Cardiologist Dr Steven Lindsay, who is fitting the device into patients at Bradford Royal Infirmary, said: “Life for patients with refractory angina is miserable.
“When we first heard about this new procedure it seemed counter-intuitive that narrowing a vein could help blood flow, but studies have proven it to be effective and safe.
“We warn patients that they won’t feel any different immediately as the stent doesn’t cause the narrowing. It’s only once the vein walls start to grow around the tube after a month or so that the symptoms start to disappear.”