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[Increased myocardial blood flow after spinal cord stimulation in patients with refractory angina pectoris]
Holger Diedrichs1, Michael Weber, Eberhard Voth
1Klinik III für Innere Medizin, Universität zu Köln, Cologne. Holger.Diedrichs@uni-koeln.de
Insights
Spinal cord stimulation (SCS) offers an effective treatment for refractory angina pectoris, improving quality of life and exercise capacity. This therapy is recommended as a first-line option for patients unsuitable for conventional treatments.
Area of Science:
- Cardiology
- Neuromodulation
- Medical Devices
Background:
- Increasing prevalence of coronary heart disease patients unsuitable for conventional treatments.
- Limitations of current surgical and catheter interventional strategies.
- Need for alternative therapeutic approaches for refractory angina pectoris.
Observation:
- Spinal cord stimulation (SCS) is recommended as a first-line therapy for refractory angina pectoris by the European Society of Cardiology.
- SCS is widely used in Europe but less common in Germany.
- Studies indicate SCS is an efficient therapy for refractory angina.
Findings:
- SCS significantly reduces angina symptoms and improves exercise capacity.
- Patients undergoing SCS report enhanced quality of life.
- Evidence suggests SCS may decrease myocardial ischemia, potentially through direct effects or improved collateralization.
Implications:
- SCS should be considered a first-line therapy for refractory angina pectoris.
- SCS does not replace conventional treatment strategies but complements them.
- Thorough patient evaluation is crucial before SCS device implantation.
Background:
In spite of great progresses in surgical and catheter interventional techniques there is an increasing number of patients with coronary heart disease not suitable for these conventional treatment strategies.
Therapy:
A recent review of the Study Group on the treatment of refractory angina pectoris of the European Society of Cardiology (ESC) recommends spinal cord stimulation (SCS) as first-line therapy. SCS is a well-known and often used therapy for refractory angina in other European countries but not in Germany. The present studies show that SCS is an efficient therapy. By reduction of angina symptoms and a consecutive increase of exercise capacity, the patients experience a great improvement in quality of life. In addition, recent data of our own study suggest a significant decrease in myocardial ischemia in patients under SCS. This might be a direct effect of SCS or due to a better collateralization because of the improved exercise capacity.
Conclusion:
In agreement with the study group of the ESC, we would recommend SCS as first-line therapy for refractory angina pectoris. As a matter of course, conventional treatment strategies should not be replaced by SCS. Hence, a strict evaluation before implanting a SCS device is indispensable.