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Angina pectoris refractory for conventional therapy--is neurostimulation a possible alternative treatment?
R W Hautvast1, M J DeJongste, G J ter Horst
1Department of Internal Medicine, Medisch Spectrum Twente, Enschede, The Netherlands.
Insights
Refractory angina pectoris, a severe condition unresponsive to standard treatments, may find relief through neurostimulation. This therapy, potentially working by improving myocardial blood flow, offers a promising alternative for patients with limited options.
Area of Science:
- Cardiology
- Neurology
- Medical Devices
Background:
- Angina pectoris, a symptom of coronary artery disease, is typically managed by restoring myocardial oxygen balance through medications or revascularization procedures.
- Recurrence of angina is common as atherosclerotic disease progresses, and not all patients are candidates for revascularization.
- Refractory angina pectoris affects patients unresponsive to medication and unsuitable for revascularization, leading to a significantly reduced quality of life.
Purpose of the Study:
- To explore neurostimulation as a therapeutic option for patients suffering from refractory angina pectoris.
- To investigate the potential mechanisms of action for neurostimulation in treating refractory angina.
Main Methods:
- Review of existing literature on neurostimulation for refractory angina pectoris.
- Analysis of proposed mechanisms, including effects on myocardial blood flow and anti-ischemic properties.
Main Results:
- Neurostimulation has been reported as an effective and safe therapy for refractory angina pectoris.
- Emerging evidence suggests neurostimulation may exert anti-ischemic effects by modulating myocardial blood flow.
Conclusions:
- Neurostimulation presents a potential alternative treatment for refractory angina pectoris in patients with limited therapeutic options.
- Further research is needed to fully establish the safety and efficacy of neurostimulation, particularly its mechanism of action, before widespread clinical adoption.
Abstract:
The treatment of angina pectoris as a symptom of coronary artery disease usually is focused on restoring the balance between oxygen demand and supply of the myocardium by administration of drugs interfering in heart rate, cardiac pre- and afterload, and coronary vascular tone. For nonresponders to drug therapy or for those with jeopardized myocardium, revascularization procedures such as coronary bypass surgery and percutaneous transluminal coronary angioplasty are at hand. However, the atherosclerotic process is not stopped by these therapies and, at longer terms, angina may recur. It is not always possible to revascularize all the patients who do not positively react to medical treatment. Those with angina, not responding to adequate medication and who are not suitable anymore for revascularization, are considered to suffer from refractory angina pectoris. This group of patients has a poor quality of life, for their exercise tolerance is severely afflicted. For these patients, neurostimulation has been described repeatedly as an effective and safe therapy. The mechanism of action of neurostimulation is not completely known, but recent studies suggest an anti-ischemic effect, exerted through changes in myocardial blood flow. As soon as its safety is sufficiently established, it may become a useful alternative in the treatment of refractory angina pectoris.