Treatment of intractable angina pectoris utilizing spinal cord stimulation

Intractable angina pectoris affects approximately 5% to 15% of patients with ischemic heart disease. Current treatment options for refractory angina can be divided into 3 groups: pharmacological, nonpharmacological noninvasive, and invasive. The newest pharmacological treatment option for intractable angina pectoris is ranolazine. Non-pharmacological, noninvasive treatment options include enhanced external counterpulsation and transcutaneous electrical nerve stimulation. Invasive treatment options include revascularization procedures: coronary artery bypass grafting, percutaneous transluminal coronary angioplasty, and percutaneous laser revascularization. Spinal cord stimulation (SCS) as a palliative intervention for refractory angina has been underutilized in the United States. This case review describes application of SCS in a 43-year-old woman with a 10-year history of symptomatic ischemic heart disease who was unresponsive to all available treatment options for intractable severe chest pain. Following spinal cord stimulator placement, the patient reported no further angina, discontinued nitroglycerine, had improved sleep quality, and resumed full-time employment.