SCS also improves homogenization of myocardial blood flow by improving coronary microvasculature dynamics.Īdditionally, SCS also modifies the capacity of intrinsic cardiac neuronal activity to facilitate relief from angina while the excitatory neuronal effects get suppressed during stimulation. Several studies have established the effect of epidural SCS on sympathetic nervous system leading to reduced myocardial oxygen demands. SCS stimulates the dorsal columns and reduces transmission of nociceptive impulses along the spinothalamic tracts modulating several neurochemicals like β-aminobutyric acid (GABA) and β-endorphins with a resultant decrease in myocardial oxygen consumption. Spinal Cord Stimulation in Angina Pectoris SCS mediates its effects by epidural stimulation which produces pain relief, reduced sympathetic tone, low myocardial oxygen perfusion, and increased microcirculation in the coronaries thereby controlling myocardial ischemia. Multiple options are available to control the symptoms that include medications, sympathectomy, behavior therapy, neuromodulation methods including ganglion blocks, nerve blocks, and spinal cord stimulation (SCS). These patients suffer from severe pain in the chest resulting in frequent hospitalizations leading to higher health care costs and reduced health-related quality of life (HRQoL) reflecting an increased burden on the society. On the other hand, the United Kingdom estimated only 16,500 new cases per year in England and as such specific figures for the United Kingdom could not be defined. Some of the many reasons for failed interventions in RA include anatomy of the coronary arteries, poor response to coronary bypass procedures or angioplasty, existing comorbidities, and combination of these factors.Ĭanadian health statistics disclose that ~500,000 Canadians suffer from RA while the American reports estimated that 600,000 to 1.8 million people have RA, with new annual addition of 75,000 patients.Įuropean studies reported annual incidence of 30,000 to 50,000 new cases. Chronic is defined as a duration of more than 3 months.” The presence of reversible myocardial ischemia should be clinically established to be the cause of the symptoms. Manheimer et al defined refractory angina (RA) as “a chronic condition characterized by the presence of angina caused by coronary insufficiency in the presence of coronary artery disease which cannot be controlled by a combination of medical therapy, angioplasty, and coronary bypass surgery. Additionally, research has shown that women with stable (defined as retrosternal chest pain associated with exertion or stress and relieved by nitroglycerin or rest) typical angina exhibit more symptoms and functional impairment. However, cardiovascular disease (CVD) remains a leading killer in women and death rates due remain higher in women compared with men. SCS with WNM could increase the indications in RA and possibly improves the outcome of these patients.Ĭonventional therapy and results for stable angina have been directed predominantly on men, while fewer women get enrolled in prospective clinical trials, for various reasons. This minimalistic wireless neuromodulation (WNM) has been successful in the management of chronic pain in failed back surgery syndrome (FBSS), herpetic neuralgia, complex regional pain syndrome (CRPS), and facial pain.
The advantage with the nanoeletrode stimulation include reduced surgical trauma/health care costs/surgical duration and improved cosmetic result, especially in women. The equipment in this minimalistic approach involved percutaneous implantation of a single electrode (with embedded microelectronic sensors) at the required anatomical location, operated by means of wireless antenna placed in the vicinity of the implant and moderated by both the patient as well as the clinician. This is the smallest pulse generator in the field of neuromodulation at present. Recent advancements in minimally invasive surgical methods and electronics resulted in implantable electrode coupled with nanotechnology-operated antenna. However, several equipment-related complications have been reported, mainly attributed to the bulky implant material and the implantable pulse generator. SCS has been in use to control RA and in some reports exhibited beneficiary results. One such minimally invasive procedure is spinal cord stimulation (SCS), a rapidly evolving therapy in the treatment of pain management. In such difficult situations, neuromodulation offers effective alternative management. Refractory angina (RA) persists even after thorough treatment for coronary artery disease. Spinal Cord Stimulation in Angina Pectoris.