title: Endoscopic thoracic sympathectomy as a novel strategy for vasospastic angina refractory to medical treatments.
abstract: Although vasospastic angina (VSA) is usually controlled by medications, refractory or lethal cases are occasionally encountered. We performed bilateral endoscopic thoracic sympathectomy (ETS) in 5 male patients with refractory VSA. Prior to ETS, stellate ganglion blockade was performed in 4 patients to reduce VSA attacks and to confirm the effect of sympathetic blockade. Under endoscopic guidance, the second to fourth thoracic sympathetic ganglia were ablated with a YAG-laser. No patient had complications after ETS, including major sweating abnormalities. In 4 of 5 patients, ETS relieved all VSA symptoms. ST-segment elevation often detected before ETS was absent on repeated ambulatory 24-h Holter monitoring after ETS. ETS is an effective strategy for the treatment of refractory VSA.
authors.affiliation: Department of Cardiovascular and Renal Medicine, Saga University Faculty of Medicine, 5-1-1 Nabeshima, Saga 849-8501, Japan.
authors.forename: Kazuyo
authors.initials: K
authors.lastname: Yoshida
authors.forename: Teruo
authors.initials: T
authors.lastname: Inoue
authors.forename: Naomi
authors.initials: N
authors.lastname: Hirakawa
authors.forename: Koichi
authors.initials: K
authors.lastname: Node
mesh_terms: D000328:Adult; D000368:Aged; D000787:Angina Pectoris / Q000601:surgery*; D003329:Coronary Vasospasm / Q000601:surgery*; D004351:Drug Resistance; D005728:Ganglia, Sympathetic / Q000601:surgery; D006801:Humans; D053685:Laser Therapy; D008297:Male; D013562:Sympathectomy / Q000379:methods*; D013906:Thoracoscopy