PMID: 15372127Sep 17, 2004Paper

Treatment of inoperable coronary disease and refractory angina: spinal stimulators, epidurals, gene therapy, transmyocardial laser, and counterpulsation

Seminars in Cardiothoracic and Vascular Anesthesia
Nelson Svorkdal

Abstract

Intractable angina from refractory coronary disease is a severe form of myocardial ischemia for which revascularization provides no prognostic benefit. Inoperable coronary disease is also accompanied by a "vicious cycle" of myocardial dystrophy from a chronic alteration of the cardiac sympathetic tone and sensitization of damaged cardiac tissues. Several adjunctive treatments have demonstrated efficacy when revascularization is either unsuccessful or contraindicated. Spinal cord stimulation modifies the neurologic input and output of the heart by delivering a very low dose of electrical current to the dorsal columns of the high thoracic spinal cord. Neural fibers then release CGRP and other endogenous peptides to the coronary circulation reducing myocardial oxygen demand and enhancing vasodilation of collaterals to improve the myocardial blood flow of the most diseased regions of the heart. Randomized study has shown the survival data at five years is comparable to bypass for high-risk patients. Transmyocardial laser revascularization creates small channels into ischemic myocardium in an effort to enhance flow though studies have shown no improvement in prognosis over medical therapy alone. Enhanced external counterpulsation us...Continue Reading

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Citations

Mar 8, 2007·Der Anaesthesist·Nils ButteP Teschendorf
Dec 1, 2012·Netherlands Heart Journal : Monthly Journal of the Netherlands Society of Cardiology and the Netherlands Heart Foundation·K De DeckerM J L Dejongste
Mar 21, 2012·The Canadian Journal of Cardiology·Michael McGillionUNKNOWN Canadian Pain Society
Jun 6, 2009·Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions·Richard GalloBradley H Strauss
Sep 10, 2014·Seminars in Cardiothoracic and Vascular Anesthesia·Carl-Johan Jakobsen
Apr 20, 2012·The Korean Journal of Pain·Seong Heon LeeWoong Mo Kim
Apr 26, 2006·Circulation Journal : Official Journal of the Japanese Circulation Society·Yanmei WangXiaodong Zhang

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