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

BACKGROUND: A 73-year-old woman with a history of complete revascularization for coronary artery disease presented with refractory angina despite multiple antianginal treatments. CASE SUMMARY: 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. DISCUSSION: 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. TAKE-HOME MESSAGES: 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.