Spinal Cord Stimulation for Long-term Treatment of Severe Angina Pectoris

What Does the Evidence Say?

Mats Börjesson; Paulin Andréll; Clas Mannheimer


Future Cardiol. 2011;7(6):825-833. 

In This Article

Treatment of Refractory Angina Pectoris

Due to the challenging pain problem, refractory angina is clinically important not only for the cardiologist, but also for other specialists such as in acute medicine, anesthesiology and pain medicine. Patients with refractory angina pectoris are greatly limited in daily function by having severe symptoms of chest discomfort and/or pain at slight effort or even at rest. The patients are frequently hospitalized and have severely impaired quality of life.[12,16,17,19]

Additional treatment modalities for refractory angina, are therefore needed. Only a few of the additional treatment modalities, which includes TENS, SCS, endoscopic thoracoscopic sympathectomy, thoracic epidural anesthesia, transmyocardial and percutaneous myocardial laser revascularization (PMR), stem cell therapy and enhanced external counterpulsation, available for refractory angina, have been extensively studied in high-quality studies.[4] Recently, several new possible pharmacological treatment alternatives have emerged, such as selective sinus node If channel inhibitors and fatty acid metabolism inhibitors. These promising methods need to be further evaluated, and are not part the current guidelines from European Society of Cardiology and American Heart Association (AHA).[3,4]

Based on available data, SCS is today considered the first-line treatment for refractory angina by the Joint Study Group for refractory angina of the European Society of Cardiology.[4] The current AHA/American College of Cardiology updated guidelines on the management of patients with chronic stable angina pectoris, gives SCS a level B recommendation, based on grade IIb evidence.[3]


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