A 79-year-old male was suffering refractory angina (daily episodes, Canadian Cardiovascular Society [CCS] class III) despite guideline-directed antianginal medical therapy including four drug classes (beta blocker, long-acting nitrate, nicorandil, ranolazine) and previous coronary artery revascularisation, and with no further suitable arterial revascularisation options after failed coronary artery bypass grafting and stenting. He was considered for a coronary sinus Reducer (Shockwave Reducer [Shockwave Medical]) implant after a multidisciplinary team discussion.
The procedure was complicated by proximal migration of the Reducer with entrapment of the delivery guide sheath at the neck of the device. Eventually, the guide sheath spontaneously disengaged, and the Reducer was anchored in the proximal coronary sinus with intentional loss of its shape, responsible for the therapeutic effect. A second Reducer was implanted distally (Moving image 1). According to institutional protocol, the patient had been on single antiplatelet therapy prior to the procedure, and dual antiplatelet therapy was planned for 6 months thereafter.
Given the complex procedure, a cardiac computed tomography (CT) at 3 months (photon-counting CT; Naeotom Alpha [Siemens Healthineers]) revealed low-attenuation material attached to the struts of...
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