BackTable Brief: COSIRA II: Managing Refractory Angina in Clinical Practice with Dr. Jai Khatri

Coronary sinus reducers: the hourglass-shaped stents that might be able to take patients back to angina-free times. In this BackTable Cardiology Brief, Dr. Jai Khatri and Dr. Ziad Ali discuss patient selection, treatment algorithms, and recent, clinical-trial backed technology for treating diffuse, multi-vessel atherosclerotic disease. They emphasize staged PCI, careful counseling, and setting realistic expectations when angiographic success doesn’t translate to symptom relief. Notably, the episode introduces the coronary sinus reducer, tracing the stent’s roots back to the Beck procedure of the 1950s. Drs. Jai and Khatri review the stent’s mechanism in the coronary sinus and review key coronary sinus reducer trials: COSIRA and COSIRA-II. The delve into COSIRA-II’s design, inclusion criteria, and best practices and recommendations for enrolling patients. --- Timestamps 00:00 - Introduction 00:59 - Diffuse Disease Challenges 02:42 - Patient Communication: Setting Expectations 05:06 - Treatment Algorithms: PCI vs CABG 07:22 - When PCI Fails Symptoms 08:35 - Coronary Sinus Reducers 10:52 - COSIRA Evidence 12:01 - COSIRA II Design 13:13 - Why Sham Control Matters 14:30 - Reducer Procedure Walkthrough 16:54 - Risks And Safety 18:41 - Enrollment And Criteria 20:11 - Wrap Up And Credits --- Check out the full episode COSIRA II: Managing Refractory Angina in Clinical Practice https://www.backtable.com/shows/cardiology/podcasts/14/cosira-ii-refractory-angina-challenges-treatment-strategies --- Resources COSIRA-II Trial https://clinicaltrials.gov/study/NCT05102019