Novel Mother-in-Child Technique to Implant Coronary Sinus Reducer in a Challenging Anatomy

A 73-year-old woman with a history of complete revascularization for coronary artery disease presented with refractory angina despite multiple antianginal treatments.

Repeated coronary angiography revealed no significant obstructive lesions. Functional invasive coronary assessment confirmed coronary microvascular dysfunction. An A-Flux coronary sinus reducer (VahatiCor) was proposed. Given a very vertically oriented coronary sinus, device deployment was challenging. We then employed a novel mother-in-child technique using a 10 F Oscor Adelante Breezaway 120 degrees catheter (Oscor) to optimize support during A-Flux implantation.

Coronary sinus reducers may provide a favorable hemodynamic response in patients with microvascular angina. The A-Flux device's design may facilitate navigation in complex anatomies, although inadequate support remains a potential limitation. The mother-in-child technique may help overcome this challenge.

Insufficient support during coronary sinus reduction procedures is a major challenge for interventionists. Using the mother-in-child technique with a 10 F Oscor Adelante Breezaway 120 degrees catheter may help address this issue in certain patients.