Angina pectoris: soon less chest pain?
Dr. med. Andrea Reiter is a freelance writer for the medical editorial team.
More about the experts All content is checked by medical journalists.MunichPeople with coronary artery disease often suffer from recurring chest pain. A new procedure could provide relief for those affected who have failed conventional therapy methods.
An hourglass-shaped stent, the “reducer”, is inserted into the vein that collects the deoxygenated blood from the heart muscle. It artificially reduces the diameter of the so-called coronary sinus. The back pressure increases the pressure in all coronary vessels - including the arteries that supply the heart muscle. The result: Sufficient oxygen-rich blood is pressed through even when the coronary arteries are already narrowed by the disease.
Small operation over the jugular vein
The effectiveness of the reducer has now been tested in a study by researchers from Tel Aviv (Israel). The group around Dr. Shmuel Banai selected 104 subjects who suffered from so-called diffuse coronary sclerosis. Because this form of coronary heart disease cannot be treated with a conventional stent, and in many cases drugs do not provide sufficient relief from chest pain.
However, only half of the subjects received the reducer in the coronary sinus. The small metal tube was pushed over the jugular vein to the mouth of the large vena cava at the heart and from there into the coronary sinus. In the other half, a “sham intervention” was carried out, ie an intervention without implantation of the narrowing stent. The jugular vein was also punctured and a control x-ray was then taken, but no reducer was left in the coronary sinus.
Chest pain diminishes
Head of Research Dr. Shmuel Banai and his team checked whether the subjects' chest pain had improved after six months. Even the scientists did not know who had received a reducer and who had not. In fact, the hourglass-shaped metal structure could help some patients who had failed medication. In a questionnaire, almost 38 study participants with reducer stated that they had significantly less pain. In contrast, only just under 23 test persons found pain relief after a sham intervention.
However, the subjective feeling did not always correlate with physical improvement. During the medical examinations, such as an ultrasound scan of the heart, the researchers could not find any significant improvement in the blood flow to the heart muscles. It therefore remains unclear whether the stent can only alleviate pain in the long term or improve the overall clinical picture.
Objective proof of effectiveness is still missing
Although the results are positive, objective evidence is important that the reducer stent actually improves blood flow to the heart muscle, says study leader Banai. This must be proven in the next phase of the study. For many people with a severe form of diffuse coronary heart disease, the stent would then be a very promising therapeutic approach. With a very straightforward procedure, it could greatly improve your quality of life.
The number one cause of death in Germany
Coronary heart disease is the leading cause of death in industrialized countries. In Germany every fifth person dies from it. In diffuse coronary sclerosis, a special form of coronary heart disease, many small vessels in the heart are simultaneously narrowed by calcifications and deposits. During physical exertion, there is a lack of oxygen in the heart muscle, which can manifest itself in chest pain on the left side. Because small arteries are affected in diffuse coronary sclerosis, it is not possible to insert a stent to expand them. Medicines often don't work either. (ar)
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