[Non-pharmacological, non-conventional therapy of chronic refractory angina pectoris]

Chronic refractory angina pectoris is a clinical entity characterized by a persistent thoracic pain, despite pharmacological therapy (Canadian Cardiovascular Society functional class 3-4); the patients show a severe, diffuse coronary atherosclerosis not amenable to myocardial revascularization at coronary angioplasty or bypass grafting. This clinical entity which is becoming ever more frequent is a cause of a poor quality of life necessitating repeated hospitalization. Many therapeutic alternatives have been proposed for the treatment of these patients, but results were inconclusive. In this review their pathophysiological background, clinical efficacy, safety and complications are analyzed. Data concerning spinal cord stimulation, upper thoracic sympathectomy, high thoracic epidural analgesia, chronic-intermittent urokinase administration, enhanced external counterpulsation and transmyocardial laser revascularization are presented. Finally, the main research directions in this particular field are reported.