Influence of cervical spinal cord stimulation on the vascular system
Various studies have shown that dorsal column stimulation (DCS) represents a useful alternative treatment in selected cases of unreconstructable peripheral (1, 13, 14, 22, 26) and coronary (5, 9, 19, 21, 23) artery disease. Despite good short- and long-term success rates (8, 11, 27), this method still faces some skepticism and criticism, particularly in surgical circles (18). This attitude is mainly due to three major drawbacks of DCS: 1) its supposed vascular effects can only be measured by microcirculatory tests which are often sophisticated and thus not easily reproducible; 2) the typical microcirculatory changes attributed to DCS (12, 13, 14, 15, 24) are characteristically confined to restricted body areas, and are therefore often considered as insufficient to achieve limb salvage in clinical practice; and 3) the DCS mode of action has as yet not been precisely established (1, 4, 15, 22, 23, 26). It is thus of crucial importance to demonstrate by the usual hemodynamic tests that the clinical successes obtained with DCS treatment cannot be attributed to any placebo effect, but to vasoactive mechanisms effectively elicited by DCS.
KeywordsPlacebo Catheter Ischemia Stein Ketamine
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