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High cervical spinal cord stimulation for unstable angina pectoris
J M González-Darder1, P Canela, V González-Martinez
1Department of Neurosurgery, Faculty of Medicine, University of Cádiz, Spain.
Insights
High cervical spinal cord stimulation (SCS) offers a low-risk treatment for severe unstable angina. This therapy significantly reduced angina attacks and improved exercise tolerance in patients ineligible for other interventions.
Area of Science:
- Cardiology
- Neuromodulation
- Medical Devices
Background:
- Unstable angina (grade IV) poses significant risks, especially when conventional treatments like beta-blockers, calcium antagonists, or revascularization are not viable.
- Patients with refractory unstable angina require alternative therapeutic strategies to manage symptoms and improve quality of life.
Purpose of the Study:
- To evaluate the efficacy and safety of high cervical spinal cord stimulation (SCS) as a treatment for patients with grade IV unstable angina.
- To assess the impact of SCS on angina frequency, severity, and exercise capacity in a cohort of treatment-resistant patients.
Main Methods:
- A prospective study involving twelve patients with grade IV unstable angina who underwent high cervical SCS implantation.
- Stimulation parameters included a pulse width of 0.1 ms, frequency of 120 Hz, and intensity adjusted to avoid paresthesias, with two 4-hour 'on' periods daily.
- Patients were followed for a mean of 9.8 months, with clinical assessments and treadmill ergometric tests conducted.
Main Results:
- Spinal cord stimulation (SCS) resulted in a statistically significant reduction in the number of angina attacks (p < 0.01) and their severity (p < 0.001).
- Treadmill ergometric tests demonstrated a significant increase in the time to angina onset and improved double product (p < 0.01).
- The SCS procedure was associated with a very low risk profile.
Conclusions:
- High cervical spinal cord stimulation (SCS) is a safe and effective therapeutic option for managing refractory grade IV unstable angina.
- SCS significantly improves clinical outcomes, including reduced angina burden and enhanced exercise tolerance, thereby improving patients' quality of life.
- This neuromodulation technique presents a valuable low-risk alternative for patients with limited treatment options for severe unstable angina.
Abstract:
Twelve patients with grade IV unstable angina were treated with high cervical spinal cord stimulation (SCS). All patients had been previously treated with maximal tolerated doses of beta-blockers and calcium antagonists and had no possibility of revascularization surgery or intraluminal angioplasty. Multipolar electrodes were implanted using a percutaneous technique, and the parameters of stimulation were pulse width 0.1 ms, frequency 120 Hz, intensity that caused no unpleasant paresthesias, with two periods of 4 h 'on' daily. After a mean follow-up of 9.8 +/- 8.2 months the clinical results show a significant reduction in the number of angina attacks (p less than 0.01) and in their grade (p less than 0.001). In the treadmill ergometric test, a significant increase in the time until angina and double product (p less than 0.01) was observed. We conclude that the SCS is a very low-risk technique that significantly increases the quality of life of patients with unstable angina.