A New Approach in the Treatment of Refractory Angina: Spinal Cord Stimulator

Angina pectoris is an important symptom of coronary heart disease. Antiischemic drugs, interventional cardiologic procedures and by-pass operations are usually helpful in the relief of angina. In some patients who had previously revascularisati on procedures or not suitable for revascularisation procedure, it may be difficult to control angina pectoris. In these patients new treatment strategies are necessary. Spinal cord stimulation is an alternative way of controlling angina. Dorsal spinal cord could be stimulated by high frequency electrical waves with the use of spinal cord stimulator (SCS). This device inhibits the delivery of pain originating from myocardial ischemia to thalamus and brain cortex and inhibits the sympathetic activity. Thus, pain, oxygen consumption of myocardium and coronary vasomotor tonus decrease. We implanted a SCS to a patient who had chest pain despite maximal medical treatment after by-pass operation. His coronary arteries were not suitable for a new revascularisation procedure. After implantation of SCS, the frequency, duration and severity of anginal episodes decreased and his quality of life was improved . This is the first case report of SCS application in Turkey and it opens a new perspective in the management of patients with refractory angina pectoris.