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1. REFRACTORY ANGINA…
NOVEL APPROACH ….
FOR BETTER QUALITY OF LIFE
AHMED T. ABDELWAHED, MD, EHRA-C
HEART CENTER, DEPARTMENT OF CARDIOLOGY, TAMPERE UNIVERSITY HOSPITAL, AND SCHOOL
OF MEDICINE,
UNIVERSITY OF TAMPERE, FINLAND;
DEPARTMENT OF CARDIOLOGY, FACULTY OF MEDICINE,
ZAGAZIG UNIVERSITY, EGYPT
3. HISTORY
• Female patient 56 y old , known DM, HTN chronic IHD with
previous CABG 10 y ago.
• presented by refractory angina CCS class III-IV in the last 2
years with on and off symptoms.
• Patient is receiving maximal intensive medical therapy trying
to control her refractory anginal pain.
• Including NICORANDIL, nitrates, BB, ivabradine, DAPT.
• Controlled her BP and Diabetic status.
• In the last 1 year, her anginal pain is intractable with multiple
hospitalization.
4. IMAGING
• CT-angiography :
chronically totally occluded both saphenous venous
grafts to OM1, and RCA.
Chronic Totally occluded RCA and LCX.
Patent LIMA to LAD.
Trial of Coronary intervention to the CTO
failed to open the vessels.
9. REFRACTOR ANGINA
Clinical condition characterized by the presence of:
1-long-lasting symptoms (≥3 months) due to objectively reversible
ischemia “evidence of ischemia as demonstrated by exercise treadmill
testing, stress imaging studies or coronary physiologic studies”
2-unmanageable by optimal medical therapy and surgical or percutaneous
revascularization,
3-including percutaneous coronary intervention (PCI) of chronic total
occlusions
--------------
Patients with refractory angina have either marked limitation of ordinary
physical activity or are unable to perform any ordinary physical activity
without discomfort (Canadian Cardiovascular Society [CCS] functional class
III or IV).
Knuuti J, et al, 2019Eur Heart J.
2020;14;41(3):407–77
30. TAKE HOME MESSAGE
• End-stage angina pectoris refractory to conventional medical therapy and not
amenable to either CABG or PCI medical therapy represents a truly desperate and
frustrating condition.
• There is no suggestion that any of the alternative treatments for refractory angina may
improve prognosis.
• The choice of treatment should be mainly based on a careful assessment of the
balance between the benefits for the disabling symptoms of patients and the risk
associated with the different treatment options.
• CS-reducer device may be a novel approach for reduction of symptoms and improve
the quality of life.
• CS-reducer device provides new approach for neovascularization and redistribution of
capillary circulation system especially subendocardial.