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Spinal cord stimulation in angina pectoris and ischemic heart disease — A topical overview

Rückenmarkstimulation in der Behandlung der Angina pectoris und ischämischer Myokarderkrankungen — eine Übersicht

  • Main Topics: Spinal Cord Stimulation In The Treatment Of Chronic Critical Limb Ischemia And Angina Pectoris
  • Published:
Acta Chirurgica Austriaca Aims and scope Submit manuscript

Summary

Background: Spinal cord stimulation has been used for the treatment of severe angina pectoris since the beginning of the 1980s. About 1500 patients have been implanted globally to date. The treatment has been shown to have a good symptom relieving effect, i.e. a reduction in the severity and frequency of anginal symptoms which is secondary to a decrease in myocardial ischemia.

Methods: The main indications at present are: severe angina pectoris despite optimum medical and surgical treatment, angina pectoris in syndrome X (angina pectoris, normal coronary arteriograms, objective signs of myocardial ischemia) and patients with angina pectoris and no prognostic benefit from coronary bypass surgery.

Results: Scientific results show that the symptom relief and reduction in myocardial ischemia seem to depend on a reduction in myocardial oxygen consumption. The treatment results in an increase in myocardial efficiency and a shift of the ischemic threshold to higher levels of myocardial performance.

Conclusions: To ensure optimum clinical results it is extremely important to select patients with current reversible myocardial ischemia in good psychological condition. Patients with cognitive dysfunction or somatoform pain disorder should be excluded. Electrostimulation therapy in angina should be handled by special units.

Zusammenfassung

Grundlagen: Die vorliegende Arbeit soll einen Überblick über den gegenwärtigen Stand der epiduralen Rückenmarkstimulation in der Behandlung der therapierefraktären Angina pectoris geben.

Methodik: Zum Einsatz kommt dieses Verfahren bei Patienten mit einer persistierenden Angina pectoris trotz medikamentöser oder chirurgischer Therapie sowie bei Patienten mit Angina pectoris, jedoch normaler Koronarangiographie (Syndrom X).

Ergebnisse: Im Vordergrund steht der schmerzlindernde Effekt der Rückenmarkstimulation, wobei in 80 bis 90% der Patienten eine signifikante Schmerzreduktion erreicht werden kann. Neben einer signifikanten Reduktion der Anfallshäufigkeit beobachteten verschiedene Autoren eine bei weitem höhere Leistungsfähigkeit. Die Wirkungsmechanismen der Stimulation sind bis heute nicht endgültig geklärt, jedoch wird eine direkte und indirekte Reduktion der Sympathikusaktivität diskutiert.

Schlußfolgerungen: Die Rückenmarkstimulation erweist sich als effektive Therapie der Angina pectoris bei austherapierten Patienten. Bei erfüllten Indikationskriterien stellt sie ein wertvolles Behandlungsprinzip dar.

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  1. Multidisciplinary Pain Center, Department of Internal Medicine, Sahlgrenska University Hospital/Östra, S-416 85, Göteborg, Sweden

    T. Eliasson

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Eliasson, T. Spinal cord stimulation in angina pectoris and ischemic heart disease — A topical overview. Acta Chir. Austriaca 32, 61–65 (2000). https://doi.org/10.1007/BF02949232

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