Advertisement

Springer Nature is making SARS-CoV-2 and COVID-19 research free. View research | View latest news | Sign up for updates

  • Main Topics: Spinal Cord Stimulation In The Treatment Of Chronic Critical Limb Ischemia And Angina Pectoris
  • Published:

Neurostimulation in patients with intractable angina pectoris

Rückenmarkstimulation bei refraktärer Angina pectoris

  • 19 Accesses

Summary

Background: The use of neurostimulation to relieve angina follows from its use in limb ischemia. In patients with “intractable” angina any therapy that improves quality of life would be of great importance. A new additional therapy for these patients is spinal cord stimulation (SCS).

Methods: Patients with severe angina pectoris, who do not respond adequately to anti-anginal medication and for whom a revascularization procedure is not a feasible option are regarded as having “intractable” angina pectoris. SCS has also been shown to relieve angina in patients with syndrome X.

Results: In patients treated with SCS an increase of working capacity and time to angina, and a fall in anginal attacks and nitrate intake was observed. Although there is some evidence that SCS is safe, there is a need to investigate the long-term effects of SCS. The method of neurostimulation is discussed in a patient with syndrome X, a patient with “intractable” angina pectoris and an inoperable patient with acute myocardial ischemia.

Conclusions: Neurostimulation is effective in the management of patients with “intractable” angina pectoris and in patients with syndrome X.

Zusammenfassung

Grundlagen: Patienten mit schwerer Angina pectoris, bei welchen eine medikamentöse Behandlung wirkungslos bleibt und bei welchen keine Indikation zur Revaskularisation besteht, sind therapierefraktär. Die epidurale Rückenmarkstimulation bietet diesen Patienten eine neue Perspektive.

Methodik: Eine Indikation für die Rückenmarkstimulation wird bei Patienten mit therapierefraktärer Angina pectoris sowie bei Patienten mit dem Syndrom X gesehen.

Ergebnisse: Unter Behandlung mit der Rückenmarkstimulation wird eine signifikante Reduktion der Anzahl pektanginöser Anfälle, eine gesteigerte Lebensqualität sowie Leistungsfähigkeit beobachtet. Die praktische Anwendung der Rückenmarkstimulation illustrieren wir anhand von 3 Beispielen. Wir behandelten 1 Patienten mit dem Syndrom X, 1 Patienten mit therapierefraktärer Angina und 1 inoperablen Patienten mit akuter Myokardischämie.

Schlußfolgerungen: Die Rückenmarkstimulation erweist sich als effektive Therapie der persistierenden Angina pectoris bei konservativ und chirurgisch austherapierten Patienten.

This is a preview of subscription content, log in to check access.

References

  1. (1)

    Andersen C, Hole P, Oxhoj H: Does pain relief with spinal cord stimulation for angina conceal myocardial infarction. Br Heart J 1994; 71: 419–421.

  2. (2)

    Augustinsson LE, Carlsson CA, Holm J, Jivegard L: Epidural electrical stimulation in severe limb ischemia. Pain relief, increased blood flow and a possible limb-saving effect. Ann Surg 1985; 202: 104–111.

  3. (3)

    Barner HB, Standeven JW, Reese J: Twelve-year experience with internal mammary arteries for coronary artery bypass. J Thorac Cardiovasc Surg 1985; 90: 668–675.

  4. (4)

    Barolat G, Schwartzman RJ, Woo R: Epidural spinal cord stimulation in the management of reflex sympathetic dystrophy. Stereotact Funt Neurosurg 1989; 3: 29–39.

  5. (5)

    Corne RA: Risk stratification in stable angina pectoris: Am J Cardiol 1987: 59: 695.

  6. (6)

    Eliasson T, Albertsson P, Hardhammar P, Emanuelsson H, Augustinsson L-E, Mannheimer C: Spinal cord stimulation in angina pectoris with normal coronary angiograms. Coronary Artery Dis 1993; 4: 819–827.

  7. (7)

    Hautvast RWM, Jongste MJL de, Blanksma PK, et al: Spinal cord stimulation causes redistribution in myocardial perfusion during dipyridamole stress testing in patients with refractory angina pectoris as assessed by 13 NH3-positron emmision tomography. Am J Cardiol 1996; 77: 462–467.

  8. (8)

    Jongste de MJL: Neurostimulation as an adjuvant therapy for patients with intractable angina pectoris. Kader presentation service, Annen, the Netherlands, 1994.

  9. (9)

    Jongste MJL de, Haaksma J, Hautvast RWM, et al: Effects of spinal cord stimulation on myocardial ischemia during normal life in patients with severe coronary artery disease. Br Heart J 1994; 71: 413–418.

  10. (10)

    Jongste MJL de, Hautvast RWM, Hillege HL, Lie KI: Efficacy of spinal cord stimulation as adjuvant therapy for intractable angina pectoris. J Am Coll Cardiol 1994; 23: 1592–1597.

  11. (11)

    Jongste MJL de, Nagelkerke D, Hooyschuur CAM, et al: Stimulation characteristics, complications, and efficacy of spinal cord stimulation systems in patients with refractory angina. PACE 1994; 17: 1751–1760.

  12. (12)

    Jongste MJL de, Staal MJ: Preliminary results of a randomized study on the clinical efficacy of spinal cord stimulation for refractory severe angina pectoris. Acta Neurochir 1993; 58: 161–164.

  13. (13)

    Kaada B: Vasodilatation induced by transcutaneous nerve stimulation in peripheral ischemia. Eur Heart J 1982; 3: 303–306.

  14. (14)

    Kirlin JW, Blackstone EH, Rodgers WJ: The plights of the invasive treatment of ischemic heart disease. J Am Coll Cardiol 1985; 5: 158–165.

  15. (15)

    Kumar K, Nath R, Wyant GM: Treatment of chronic pain by epidural spinal cord stimulation: a 10-year experience. J Neurosurg 1991; 5: 402–407.

  16. (16)

    Mannheimer C, Eliasson T, Andersson B, et al: Effects of spinal cord stimulation in angina pectoris induced by pacing and possible mechanisms of action. Br Med J 1993; 307: 477–480.

  17. (17)

    Marchand S, Bushnell MC, Duncan GH: Modulation of heat perception by high frequency transcutaneous electrical nerve stimulation. Clin J Pain 1991; 7: 122–129.

  18. (18)

    Melzack R, Wall PD: Pain mechanisms: a new theory. Science 1965; 150: 971–979.

  19. (19)

    Murphy DF, Giles KE: Dorsal column stimulation for pain relief from intractable angina pectoris. Pain 1987: 28: 365–368.

  20. (20)

    North RB, Ewend MG, Lawton MT, Kidd DH, Piantadosi S: Failed back surgery syndrome: five-year follow-up after spinal cord stimulator implantation. Neurosurgery 1991; 28: 692–699.

  21. (21)

    Shealy CN, Mortimor JT, Reswick JB: Electrical inhibition of pain by stimulation of the dorsal columns. Anesth Analg 1967; 46: 489–491.

  22. (22)

    Turner JA, Loeser JD, Bell KG: Spinal cord stimulation for chronic low back pain: a systematic literature synthesis. Neurosurgery 1995; 37: 1088–1096.

  23. (23)

    Wall PD, Sweet WH: Temporary abolition of pain in man. Science 1967; 155: 108–109.

Download references

Author information

Correspondence to Margreeth Oosterga.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Oosterga, M., de Jongste, M.J.L. Neurostimulation in patients with intractable angina pectoris. Acta Chir. Austriaca 32, 58–60 (2000). https://doi.org/10.1007/BF02949230

Download citation

Keywords

  • Refractory angina pectoris
  • neurostimulation
  • efficacy
  • safety
  • complications

Schlüsselwörter

  • Refraktäre Angina pectoris
  • Rückenmarkstimulation
  • Effektivität
  • Sicherheit
  • Komplikationen