Neuromodulation in patients with refractory angina pectoris: a review

Area of Science:

• Cardiology
• Neuromodulation
• Medical Devices

Background:

• Refractory angina pectoris (RAP) is a growing condition in patients with coronary artery disease (CAD) unresponsive to standard treatments.
• Estimates suggest 5-10% of stable CAD patients experience RAP, with significant annual new cases in the USA and Europe.
• RAP is defined as chronic angina (over 3 months) with diffuse CAD and ischemia, untreatable by medical therapy, angioplasty, or bypass surgery.

Purpose of the Study:

• To provide an overview of neuromodulation as a treatment for refractory angina pectoris (RAP).
• To review spinal cord stimulation (SCS) as a therapeutic option for patients with RAP.
• To discuss the history, mechanism, safety, efficacy, and current application of SCS in managing RAP.

Main Methods:

• Literature review focusing on neuromodulation and spinal cord stimulation (SCS) for refractory angina pectoris (RAP).
• Analysis of existing data on the history, proposed mechanisms, safety, and efficacy of SCS.
• Examination of current clinical guidelines and use of SCS in managing chronic coronary syndromes.

Main Results:

• Spinal cord stimulation (SCS) is recognized as a Class IIb, Level B recommendation for RAP in the 2019 ESC guidelines.
• The review covers the historical development and proposed mechanisms of action for SCS in treating angina.
• Data on the safety and efficacy of SCS for refractory angina pectoris (RAP) are presented.

Conclusions:

• Spinal cord stimulation (SCS) represents a viable last-resort treatment option for patients with refractory angina pectoris (RAP).
• Neuromodulation, specifically SCS, offers a potential therapeutic avenue for managing this challenging patient group.
• Further research and clinical application of SCS are warranted for refractory angina pectoris (RAP).