Epidural spinal cord stimulation in chronic refractory angina pectoris

Chronic refractory angina pectoris is defined as a condition with coronary insufficiency that cannot be controlled by a combination of medical therapy, angioplasty or bypass surgery. Different treatment options are evaluated in this patient group; spinal cord stimulation (SCS) is the one that is best documented. We have used this method since 1996 and present our experience. From 1996 to 2001, spinal cord stimulators were implanted in 21 patients. A follow-up study was performed after 27 months (range 7-71) with a questionnaire. Preoperative clinical and angiographic data were retrieved from our records. 17 men and 4 women aged 55-88 years (median 73) were treated with SCS. Preoperatively all patients were in CCS (Canadian Cardiovascular Society) class III-IV. 81% had previously undergone coronary artery bypass surgery. At follow up, 81% were alive. Lead fracture occurred in two patients, displacement of the electrode in one. There were no other complications. 71% reported symptomatic improvement, mean CCS class was reduced from 3.5 prior to SCS to 2.2 at follow up, and use of nitroglycerin was reduced. In chronic refractory angina pectoris, spinal cord stimulation is an alternative. We report "beginners' experience" that is positive including substantial symptomatic effect and a low complication rate. More hospitals in Norway should consider establishing SCS in order to offer this treatment option to a growing patient group.