[Increased myocardial blood flow after spinal cord stimulation in patients with refractory angina pectoris].
BACKGROUND
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.


METHODS
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. SCS is a well-known and often used therapy for refractory angina in other European countries but not in Germany. The present studies show that SCS is an efficient therapy. 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 in patients under SCS. This might be a direct effect of SCS or due to a better collateralization because of the improved exercise capacity.


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.
Diedrichs
Holger
H
Klinik III für Innere Medizin, Universität zu Köln, Cologne. Holger.Diedrichs@uni-koeln.de
Weber
Michael
M
Voth
Eberhard
E
Koulousakis
Atanasios
A
Zobel
Carsten
C
Schwinger
Robert H G
RH
D000368:Aged; D000787:Angina Pectoris / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D015906:Angioplasty, Balloon, Coronary; D003097:Collateral Circulation / Q000502:physiology; D017023:Coronary Angiography; D003326:Coronary Circulation / Q000502:physiology*; D023903:Coronary Restenosis / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy; D004599:Electric Stimulation Therapy / Q000295:instrumentation*; D004567:Electrodes, Implanted; D004824:Epidural Space; D005080:Exercise Test; D005260:Female; D006801:Humans; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D019736:Prostheses and Implants; D013116:Spinal Cord / Q000503:physiopathology*; D015899:Tomography, Emission-Computed, Single-Photon; D016896:Treatment Outcome