Invasive Therapies for Refractory Angina: Current Perspectives

• DOI: https://doi.org/10.22533/at.ed.1595232528053

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• Abstract:

  Refractory angina (RA) is a debilitating condition that is difficult to manage clinically, characterized by persistent chest pain associated with myocardial ischemia, even after optimized pharmacological therapy and exhaustion of revascularization options. With a growing prevalence, driven by population aging and an increase in chronic diseases, RA represents a significant challenge, especially in cases with microvascular dysfunction.
  This paper reviews the main emerging invasive therapies for the treatment of RA, with a focus on the Coronary Sinus Reducer (CSR), which redistributes blood flow to ischemic subendocardial regions. Data from the COSIRA study and multicenter registries demonstrate functional improvement and safety of the CSR, although there is still a need for large-scale validation.
  Other approaches analyzed include percutaneous coronary intervention (PCI) for chronic total occlusion (CTO), with increasing success rates in specialized centers, and transmyocardial laser revascularization (TMR), whose use has been limited by conflicting results. Neuromodulation and extracorporeal shockwave therapy (ESWT) are also showing promise, especially in patients who are not eligible for conventional therapies, with evidence of improved function and quality of life.
  We conclude that, given the limitations of traditional therapies and the growth of the RA population, there is an urgent need to expand access to and research into invasive and minimally invasive strategies, promoting an individualized and multidisciplinary approach to the management of this complex condition.