ANGINA-PECTORIS REFRACTORY FOR CONVENTIONAL THERAPY - IS NEUROSTIMULATION A POSSIBLE ALTERNATIVE TREATMENT

The treatment of angina pectoris as a symptom of coronary artery disea se usually is focused on restoring the balance between oxygen demand a nd supply of the myocardium by administration of drugs interfering in heart rate, cardiac pre- and afterload, and coronary vascular tone. Fo r nonresponders to drug therapy or for those with jeopardized myocardi um, revascularization procedures such as coronary bypass surgery and p ercutaneous transluminal coronary angioplasty are at hand. However, th e atherosclerotic process is not stopped by these therapies and, at lo nger terms, angina may recur. It is not always possible to revasculari ze all the patients who do not positively react to medical treatment. Those with angina, not responding to adequate medication and who are n ot suitable anymore for revascularization, are considered to suffer fr om refractory angina pectoris. This group of patients has a poor quali ty of life, for their exercise tolerance is severely afflicted. For th ese patients, neurostimulation has been described repeatedly as an eff ective and safe therapy. The mechanism of action of neurostimulation i s not completely known, but recent studies suggest an anti-ischemic ef fect, exerted through changes in myocardial blood flow. As soon as its safety is sufficiently established, it may become a useful alternativ e in the treatment of refractory angina pectoris.