Article
Increased myocardial blood flow after spinal cord stimulation in patients with refractory Angina Pectoris
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Authors
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A. Koulousakis
- Klinik für Stereotaxie und Funktionelle Neurochirurgie, Klinikum der Universität zu Köln
| Published: | May 20, 2009 |
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Outline
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Objective: In spite of great progresses in surgical and catheter interventional techniques there is an increasing number of patients with coronary heart disease not suitable for these conventional treatment strategies. A number of patients suffer from intractable pain in spite of appropriate medication. A recent review of the Study Group on the treatment of refractory angina pectoris of the European Society of Cardiology (ESC) recommends spinal cord stimulation (SCS) as first-line therapy.
Methods: 30 patients were randomized for SCS after a strong selection protocol, according to the ESBY study (Mannheimer 1998). The protocol includes the Seattle Angina Questionnaire, stress tolerance (Walktest, Ergometry), heart szintigraphy and heart catheter examinations. Follow ups were conducted after 3, as well as 12 months (symptoms, walktest, ergometry, and szintigraphy, drug medication and quality of life). The quadropolar electrode was placed at the level Th1-left paramedian and after a trial period it was connected to a programmable pulse generator. By reduction of angina symptoms and a consecutive increase of exercise capacity, the patients experience a great improvement in quality of life. In addition, recent data of our own study suggest a significant decrease in myocardial ischemia – examined by MIBI-SPECT – in 23 patients under SCS. After 1 year of SCS, a significant improvement of the myocardial blood flow was registered in 16 patients, while being equal in 10. This might be a direct effect of SCS perhaps due to sympaticolysis or due to a better collateralization because of the improved exercise capacity.
Results: The present study in 30 patients shows that SCS is an efficient therapy.
Conclusions: In agreement with the study group of the ESC, we would recommend SCS as first-line therapy for refractory angina pectoris. As a matter of course, conventional treatment strategies should not be replaced by SCS. Hence, a strict evaluation before implanting a SCS device is indispensable.
