BackTable Cardiology

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

BackTable Cardiology

Show 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

https://www.backtable.com/shows/cardiology/podcasts/14/cosira-ii-refractory-angina-challenges-treatment-strategies

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Resources

COSIRA-II Trial

https://clinicaltrials.gov/study/NCT05102019

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