Neuromodulation in patients with Refractory Angina Pectoris – A Review


 The number of patients with coronary artery disease (CAD) who have persisting angina pectoris despite optimal medical treatment known as refractory angina pectoris (RAP) is growing. Current estimates indicate that 5 to 10% of patients with stable CAD have RAP. In absolute numbers there are 50,000 to 100,000 new cases of RAP each year in the United States and 30,000 to 50,000 new cases each year in Europe. The term RAP was formulated in 2002. RAP is defined as a chronic disease (more than three months) characterized by diffuse coronary artery disease in the presence of proven ischemia which is not amendable to a combination of medical therapy, angioplasty or coronary bypass surgery.
 There are currently few treatment options for patients with RAP. One such last-resort treatment option is spinal cord stimulation (SCS) with a Class of recommendation IIB, level of evidence B in the 2019 European Society of Cardiology Guidelines for the diagnosis and management of chronic coronary syndromes. The aim this review is to give an overview of neuromodulation as treatment modality for patients with RAP. A comprehensive overview is given on the history, proposed mechanism of action, safety, efficacy and current use of SCS.