Technical Strategies in Spinal Cord Stimulation for Refractory Angina: A Narrative Review.

Area of Science:

• Cardiovascular Medicine
• Neurosurgery
• Pain Management

Background:

• Refractory angina (RA) is persistent chest pain unresponsive to standard treatments.
• Spinal cord stimulation (SCS) is an adjunctive therapy for RA, but implantation techniques vary.
• Technical aspects of SCS implantation for RA lack standardization.

Purpose of the Study:

• To review and synthesize technical strategies for SCS implantation in RA patients.
• To identify common practices and variations in SCS implantation procedures for RA.
• To highlight inconsistencies in reporting technical parameters for SCS in RA.

Main Methods:

• A narrative review of the literature was performed.
• Searched PubMed and Embase databases (1987-2025) for studies on SCS in RA or chronic angina.
• Included studies reporting technical details of SCS implantation, such as lead placement and stimulation programming.

Main Results:

• Lead placement commonly at T1-T2 or C7-T1, with some cervical placements.
• Intraoperative paresthesia mapping used inconsistently for optimizing pain coverage.
• Tonic stimulation is most studied; other paradigms like subthreshold and burst stimulation show potential.
• Trial phase methodologies varied significantly.

Conclusions:

• Significant heterogeneity exists in reported technical parameters for SCS implantation in RA.
• Inconsistent reporting hinders the establishment of best practices.
• Further rigorous studies are required to compare technical approaches and stimulation paradigms for optimal SCS use in RA.