Complex coronary disease and refractory angina

We provide a holistic approach to managing refractory angina, including access to an angina clinical nurse specialist (CNS) who can advise on approaches to limiting the impact of angina on daily life, lifestyle advice and telephone follow-up. 

  • Treatment includes providing a full clinical assessment and access to a comprehensive range of advanced scanning techniques for diagnosis, performed by leading imaging specialists.  
  • When a patient is referred to us, we discuss each case at a multidisciplinary meeting. This allows us to review the patient's condition in detail and consider any relevant investigations, bringing all the varied expertise of our team together. A tailored management plan is developed for each patient.
  • We will review and, if necessary, modify tablet treatment.
  • In appropriate cases, we will be happy to offer advanced angioplasty techniques or redo bypass surgery, which will be delivered by a highly experienced team of interventional cardiologists and cardiac surgeons.
  • We are able to offer a comprehensive range of medical and pain management treatments, following review by a specialist consultant in pain medicine.
  • Psychological support services are also available.
  • Local, national and international referrals accepted

Coronary sinus reducer

The Trust is one of a few centres in the world to offer coronary sinus reducer, an innovative, new treatment for refractory angina. It involves inserting a small device (the reducer) to narrow the coronary sinus. This is the main vein that carries blood out of the heart. 

A research study has shown that those patients who received a reducer, had less angina and improved quality of life. To see if you are suitable and would benefit from this treatment, you will need to be assessed and have some investigations beforehand. 

The angina team

Royal Brompton & Harefield NHS Foundation Trust has a specialist multidisciplinary team of healthcare professionals, headed by Dr Ranil De Silva, who are dedicated to the investigation and treatment of patients with complex coronary disease and refractory angina.

Ranil De Silva - consultant cardiologist and interventionalist

Carlo Di Mario - professor in interventional cardiology

Tony De Souza - consultant cardiovascular surgeon

Glyn Towlerton - consultant in pain medicine

Anne-Marie Doyle - clinical psychologist

Julie Copps - clinical nurse specialist


Richard Underwood - professor in nuclear medicine

Roxy Senior - professor in echocardiography

Mike Rubens - consultant radiologist (CT)

Dudley Pennell - professor of cardiac magnetic resonance

Contact us

Dr Ranil De Silva

Consultant cardiologist
Tel: 020 7351 8626

Christine Wright

CNS in angina
020 7351 8645

Read about the cardiac rehabilitation service at Harefield Hospital

Helping patients through research

We are also engaged in research investigating new treatments for those patients who are eligible and interested in participating in clinical studies.

We are actively involved in the following clinical trials and consider it a vital part of increasing our knowledge and advancing the treatment of coronary disease.

  • COSIRA - coronary sinus reducer for the treatment of refractory angina
  • Apheresis in refractory angina
  • Cell therapy in the treatment of refractory angina

Useful links

British Heart Foundation - information about angina 

NICE - management of stable angina