Dr Ranil De Silva awarded funding to the BHF to determine whether hourglass stents could be used to help patients with chest pain.

Could hourglass stents be used to help patients with chest pain (angina) caused by normal coronary artery ischemia (INOCA)? That’s the question the researchers hope to answer, with funding from the British Heart Foundation (BHF).

“This is a critical first step towards the development of the first interventional treatment for patients with INOCA and coronary microvascular dysfunction, which has the potential to transform care for these patients.” Dr Ranil De Silva

With the help of his team, Dr Ranil De Silva, consultant cardiologist at Royal Brompton and Harefield hospitals and senior lecturer in clinical cardiology at Imperial College London, will test the new stent in a subset of patients with ‘INOCA.

Patients with INOCA suffer from angina pectoris caused by restriction of blood flow to the heart muscle. However, unlike coronary artery disease (CAD), the coronary arteries on the surface of the heart are normal. In these patients, it is believed that the decrease in blood supply to the heart muscle is caused by abnormal functioning of the small blood vessels that are integrated into the heart muscle, which play a central role in controlling blood flow to the heart. This is called coronary microvascular dysfunction.

Studies have shown that patients with INOCA and coronary microvascular dysfunction have an increased risk of poor health outcomes and hospitalizations, as well as poor quality of life.

Current treatment options for patients with INOCA and coronary microvascular dysfunction are limited. Although the guidelines recommend a variety of drug treatments, there is little solid clinical trials to support these recommendations. Importantly, there is no procedure-based treatment available to help improve blood flow to the heart and reduce symptoms in this group of patients.

New hope?

The research team, with support from the BHF, aims to conduct the REMEDY-PILOT study to assess whether the placement of an hourglass-shaped stainless steel stent, known as a reducer, in the sinus coronary artery (the main vein of the heart) is an acceptable solution. for patients and will improve blood circulation in the heart of patients with angina pectoris and INOCA.

Dr De Silva and his team believe that by narrowing the coronary sinus, the reducer will help redistribute blood flow to areas of the heart where blood flow is restricted, thereby reducing the patient’s symptoms of chest pain.

Dr De Silva says:

“There are a large number of patients with chest pain who have no signs of conventional coronary artery disease, but whose chest pain can still be caused by decreased blood flow to the heart. The diagnosis is often not made, and their treatment options are very limited. This is a very important opportunity for us to rigorously assess whether and how the implantation of reducers can help patients in this group.

“This is a critical first step towards the development of the first interventional therapy for patients with INOCA and coronary microvascular dysfunction, which has the potential to transform care for these patients. We are extremely grateful to the BHF for recognizing the importance of supporting research to address the unmet clinical needs of this patient group.

If successful, the REMEDY-PILOT study will provide the basis for a future multicenter clinical trial of implantation of reductant in patients with INOCA and coronary microvascular dysfunction, which will definitively answer the question of whether Reducer implantation improves angina symptoms and quality of life in patients with INOCA and coronary microvascular dysfunction.

The trial is scheduled to begin in October 2021.


This article was originally published by Zahra Aden on the web pages of the Royal Brompton and Harefield Hospital – see the original article.



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