Coronary sinus delivery systems

Transcoronary venous injection is performed with a catheter system threaded percutaneously into the coronary sinus. Initial studies in swine have confirmed the feasibility and safety of this approach [121]. This delivery method has also been used to deliver skeletal myoblasts to scarred myocardium in cardiomyopathy patients [120]. With intravascular ultrasound guidance, this approach allows the operator to extend a catheter and needle away from the pericardial space and coronary artery into the adjacent myocardium. To date, human feasibility studies have had a good safety profile. This technique is limited, however, by coronary venous tortuosity, lack of site specific targeting, and its own technically challenging nature. Unlike the transendocardial approach, in which cells are... 

Table 4.13 Components of delivery system for coronary sinus cannulation.

Locating the coronary sinus os can be quite problematic, given the heart failure patient s distorted anatomy. Table 4.16 outlines the techniques devised to can-nulate the coronary sinus. If a simple stylet-driven lead coronary sinus placement is undertaken, then coronary sinus access is dependent on the operator s skill, knowledge of the coronary sinus anatomy, and favorable tributaries for safe, reliable placement. Coronary sinus os localization is much easier with a guiding catheter delivery system. The operator simply selects the guiding... 

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