Cervical Spinal Cord Stimulation in the Treatment of Severe Angina Pectoris

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Abstract

Summary

Spinal cord stimulation (SCS) is a useful surgical technique tor the treatment of chronic pain, including vasculopathic pain. In this clinical study. SCS was used to treat a selected group of patients with intractable angina pectoris. Clinical criteria for inclusion were diagnosis of stable class 3-f angina pectoris, with at least 3 months of nonresponse to maximum tolerable pharmacologic treatment, and no indication for other surgical procedures. Our 23 patients suffered angina pectoris secondary to arteriosclerotic coronary artery disease. A percutaneous technique was used for electrode implantation and the upper cervical spinal cord was stimulated within the parameters of 120 Hz frequency, pulse width of 0.1 ms. and the maximum intensity to cause not-unpleasant paresthesias to the patient. Initial pattern of stimulation was 4 hours in the morning and 4 hours in the afternoon. Our results demonstrate the efficacy of high cervical SCS in the treatment of severe angina pain with no major complications. Neurostimulation does not change the natural history of the coronary disease, but all patients experienced improved quality of life. In addition, SCS does not mask pain secondary to myocardial infarction. Several mechanisms of action have been invoked to explain these clinical results of SCS. The main mechanism would be analgesia by means of activation of descending inhibitory systems; a secondary nism would be the blocking of some segmentary autonomic responses developed in response to myocardial ischemia.

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