
BackTable Brief: COSIRA II: Managing Refractory Angina in Clinical Practice with Dr. Jai Khatri
BackTable CardiologyShow Notes
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.
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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
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Check out the full episode
COSIRA II: Managing Refractory Angina in Clinical Practice
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Resources
COSIRA-II Trial
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