Percutaneous coronary intervention (PCI) and cardiac by-pass surgery remains the corner stone management for severe angina, myocardial ischemia and myocardial infarction. But there are instances when patient may not be a candidate for both the procedures. Coronary sinus remains the potential site for alternative approach in these situations. Pratt was the first to describe use of coronary sinus to deliver arterial blood to ischemic myocardium. Beck was an important pioneer in developing Beck I procedure which includes surgically narrowing the coronary sinus and elevating the coronary venous pressures in association with partial pericardiectomy. In the Beck II procedure, the coronary venous system was arterialized. Later coronary sinus lost its charm with development of PCI. In this study, I explored the opportunity to consolidate and review the anatomy, various physiological and biochemical aspects, therapeutic approaches in invasive cardiology and future research prospects in a nutshell. The routine use of coronary sinus for electrophysiological is well known and is described briefly as well in this article.