[Epidural spinal cord stimulation in chronic refractory angina pectoris]

Area of Science:

• Cardiovascular Medicine
• Neurosurgery
• Pain Management

Context:

• Chronic refractory angina pectoris (CRAP) presents a significant challenge due to persistent coronary insufficiency unresponsive to standard therapies.
• Limited treatment options exist for CRAP patients, necessitating exploration of alternative interventions.
• Spinal cord stimulation (SCS) has emerged as a documented treatment modality for refractory angina.

Purpose:

• To evaluate the efficacy and safety of spinal cord stimulation (SCS) in patients with chronic refractory angina pectoris (CRAP).
• To present the "beginners' experience" with SCS implantation and long-term follow-up.
• To assess symptomatic improvement and complication rates associated with SCS in this patient cohort.

Summary:

• A cohort of 21 patients (17 men, 4 women; median age 73) with severe CRAP (CCS class III-IV) underwent SCS implantation between 1996 and 2001.
• After a median follow-up of 27 months, 71% of patients reported symptomatic improvement, with a reduction in Canadian Cardiovascular Society (CCS) class from 3.5 to 2.2 and decreased nitroglycerin use.
• The study reported a low complication rate, with lead fracture in two patients and electrode displacement in one, while 81% of patients survived.

Impact:

• Spinal cord stimulation (SCS) demonstrates potential as a viable alternative treatment for chronic refractory angina pectoris (CRAP).
• The positive outcomes, including substantial symptomatic relief and a low complication rate, support the wider adoption of SCS in Norway.
• Establishing SCS as a treatment option can benefit a growing patient population suffering from refractory angina.