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Paz Y, Levy Y, Grosman-Rimon L, Shinfeld A. Nonpharmacological interventions for 'no-option' refractory angina patients. J Cardiovasc Med (Hagerstown) 2024; 25:13-22. [PMID: 37942734 DOI: 10.2459/jcm.0000000000001566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2023]
Abstract
Refractory angina pectoris (RAP) defined as chronic anginal chest pain because of coronary artery disease (CAD) is a major problem. The increase in the number of patients with RAP in recent years is because of the increasing aging population and improved survival rates among patients with CAD. Management of patients with RAP is often extremely challenging. In this review, we present several interventional approaches for RAP, including device therapies, lifestyle intervention, and cell therapies. Some of these treatments are currently used in the management of RAP, whereas other treatments are under investigation.
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Affiliation(s)
- Yoav Paz
- General Intensive Care Unit, Sourasky Medical Center, Tel Aviv, Israel, affiliated with Sackler Faculty of Medicine, Tel Aviv University
| | - Yair Levy
- Department of Medicine, Meir Hospital, Kfar-Saba, Israel
| | - Liza Grosman-Rimon
- School of Graduate Studies, Levinsky-Wingate Academic College, Wingate Institute, Netanya, Israel
| | - Amihay Shinfeld
- Department of Cardiac Surgery, Sheba Medical Center, Tel Hashomer, Tel Aviv, Israel
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2
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Abstract
The combination of an aging population and improved survival rates among patients with coronary artery disease has resulted in an increase in the number of patients with refractory angina or anginal equivalent symptoms despite maximal medical therapy. Patients with refractory angina are often referred to the cardiac catheterization laboratory; however, they have often exhausted conventional revascularization options; thus, this population is often deemed as having "no options." We review the definition, prevalence, outcomes, therapeutic options, and treatment considerations for no-option refractory angina patients and focus on novel therapies for this complex and challenging population. We propose a multidisciplinary team approach for the evaluation and management of patients with refractory angina, ideally in a designated clinic. The severe limitations and symptomatology experienced by these patients highlight the need for additional research into the development of innovative treatments.
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Affiliation(s)
- Thomas J Povsic
- Department of Medicine, Program for Advanced Coronary Disease, Duke University Medical Center and Duke Clinical Research Institute, Durham, NC (T.J.P., E.M.O.)
| | - Timothy D Henry
- The Carl and Edyth Lindner Center for Research and Education at The Christ Hospital, Cincinnati, OH (T.D.H.)
| | - E Magnus Ohman
- Department of Medicine, Program for Advanced Coronary Disease, Duke University Medical Center and Duke Clinical Research Institute, Durham, NC (T.J.P., E.M.O.)
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3
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Abstract
The article discusses pharmacologic and interventional therapeutic options for patients with refractory angina. Refractory angina refers to long-lasting symptoms (≥3 months) due to established reversible ischemia in the presence of obstructive coronary artery disease, which cannot be controlled by escalating medical therapy with second-line and third-line pharmacologic agents, bypass grafting, or stenting. Due to an aging population, increased number of comorbidities, and advances in coronary artery disease treatment, incidence of refractory angina is growing. Although the number of therapeutic options is increasing, there is a lack of randomized clinical trials that could help create recommendations for this group of patients.
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Affiliation(s)
- Marcin Makowski
- Department of Interventional Cardiology, Medical University of Lodz, Central Clinical Hospital, ul. Pomorska 251, Lodz 92-213, Poland.
| | | | - Marzenna Zielińska
- Department of Interventional Cardiology, Medical University of Lodz, Central Clinical Hospital, ul. Pomorska 251, Lodz 92-213, Poland
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4
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Neuromodulation for Refractory Angina and Heart Failure. Neuromodulation 2018. [DOI: 10.1016/b978-0-12-805353-9.00106-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Billet B, Wynendaele R, Vanquathem NE. A Novel Minimally Invasive Wireless Technology for Neuromodulation via Percutaneous Intercostal Nerve Stimulation for Post-Herpetic Neuralgia: A Case Report with Short-Term Follow-up. Pain Pract 2017. [DOI: 10.1111/papr.12607] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Giannini F, Aurelio A, Jabbour RJ, Ferri L, Colombo A, Latib A. The coronary sinus reducer: clinical evidence and technical aspects. Expert Rev Cardiovasc Ther 2016; 15:47-58. [DOI: 10.1080/14779072.2017.1270755] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Francesco Giannini
- Interventional Cardiology Unit, San Raffaele Hospital, Milan, Italy
- Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy
| | - Andrea Aurelio
- Interventional Cardiology Unit, San Raffaele Hospital, Milan, Italy
- Cardiovascular Department, Casa di Cura Villa Verde, Taranto, Italy
| | - Richard J. Jabbour
- Interventional Cardiology Unit, San Raffaele Hospital, Milan, Italy
- Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy
| | - Luca Ferri
- Interventional Cardiology Unit, San Raffaele Hospital, Milan, Italy
- Cardiovascular Department, Ospedale A. Manzoni, Lecco, Italy
| | - Antonio Colombo
- Interventional Cardiology Unit, San Raffaele Hospital, Milan, Italy
- Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy
| | - Azeem Latib
- Interventional Cardiology Unit, San Raffaele Hospital, Milan, Italy
- Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy
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Ielasi A, Todaro MC, Grigis G, Tespili M. Coronary Sinus Reducer system™: A new therapeutic option in refractory angina patients unsuitable for revascularization. Int J Cardiol 2016; 209:122-30. [DOI: 10.1016/j.ijcard.2016.02.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Accepted: 02/01/2016] [Indexed: 10/22/2022]
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Deer TR, Mekhail N, Provenzano D, Pope J, Krames E, Leong M, Levy RM, Abejon D, Buchser E, Burton A, Buvanendran A, Candido K, Caraway D, Cousins M, DeJongste M, Diwan S, Eldabe S, Gatzinsky K, Foreman RD, Hayek S, Kim P, Kinfe T, Kloth D, Kumar K, Rizvi S, Lad SP, Liem L, Linderoth B, Mackey S, McDowell G, McRoberts P, Poree L, Prager J, Raso L, Rauck R, Russo M, Simpson B, Slavin K, Staats P, Stanton-Hicks M, Verrills P, Wellington J, Williams K, North R. The appropriate use of neurostimulation of the spinal cord and peripheral nervous system for the treatment of chronic pain and ischemic diseases: the Neuromodulation Appropriateness Consensus Committee. Neuromodulation 2015; 17:515-50; discussion 550. [PMID: 25112889 DOI: 10.1111/ner.12208] [Citation(s) in RCA: 319] [Impact Index Per Article: 35.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Revised: 01/07/2014] [Accepted: 02/28/2014] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The Neuromodulation Appropriateness Consensus Committee (NACC) of the International Neuromodulation Society (INS) evaluated evidence regarding the safety and efficacy of neurostimulation to treat chronic pain, chronic critical limb ischemia, and refractory angina and recommended appropriate clinical applications. METHODS The NACC used literature reviews, expert opinion, clinical experience, and individual research. Authors consulted the Practice Parameters for the Use of Spinal Cord Stimulation in the Treatment of Neuropathic Pain (2006), systematic reviews (1984 to 2013), and prospective and randomized controlled trials (2005 to 2013) identified through PubMed, EMBASE, and Google Scholar. RESULTS Neurostimulation is relatively safe because of its minimally invasive and reversible characteristics. Comparison with medical management is difficult, as patients considered for neurostimulation have failed conservative management. Unlike alternative therapies, neurostimulation is not associated with medication-related side effects and has enduring effect. Device-related complications are not uncommon; however, the incidence is becoming less frequent as technology progresses and surgical skills improve. Randomized controlled studies support the efficacy of spinal cord stimulation in treating failed back surgery syndrome and complex regional pain syndrome. Similar studies of neurostimulation for peripheral neuropathic pain, postamputation pain, postherpetic neuralgia, and other causes of nerve injury are needed. International guidelines recommend spinal cord stimulation to treat refractory angina; other indications, such as congestive heart failure, are being investigated. CONCLUSIONS Appropriate neurostimulation is safe and effective in some chronic pain conditions. Technological refinements and clinical evidence will continue to expand its use. The NACC seeks to facilitate the efficacy and safety of neurostimulation.
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Walega D, Rosenow JM. Spinal Cord Stimulation for Electrical Storm Refractory to Conventional Medical Treatment: An Emerging Indication? Neuromodulation 2015; 18:194-6; discussion 196. [DOI: 10.1111/ner.12200] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2014] [Revised: 03/15/2014] [Accepted: 04/04/2014] [Indexed: 11/29/2022]
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De Andres J, Sanchis-Lopez N, Asensio-Samper JM, Fabregat-Cid G, Villanueva-Perez VL, Monsalve Dolz V, Minguez A. Vulvodynia-An Evidence-Based Literature Review and Proposed Treatment Algorithm. Pain Pract 2015; 16:204-36. [DOI: 10.1111/papr.12274] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2014] [Accepted: 11/05/2014] [Indexed: 01/23/2023]
Affiliation(s)
- Jose De Andres
- Valencia University Medical School; Valencia Spain
- Department of Anesthesiology Critical Care and Pain Management; General University Hospital; Valencia Spain
- Multidisciplinary Pain Management Department; General University Hospital; Valencia Spain
| | - Nerea Sanchis-Lopez
- Department of Anesthesiology Critical Care and Pain Management; General University Hospital; Valencia Spain
- Multidisciplinary Pain Management Department; General University Hospital; Valencia Spain
| | - Juan Marcos Asensio-Samper
- Department of Anesthesiology Critical Care and Pain Management; General University Hospital; Valencia Spain
- Multidisciplinary Pain Management Department; General University Hospital; Valencia Spain
| | - Gustavo Fabregat-Cid
- Department of Anesthesiology Critical Care and Pain Management; General University Hospital; Valencia Spain
- Multidisciplinary Pain Management Department; General University Hospital; Valencia Spain
| | - Vicente L. Villanueva-Perez
- Department of Anesthesiology Critical Care and Pain Management; General University Hospital; Valencia Spain
- Multidisciplinary Pain Management Department; General University Hospital; Valencia Spain
| | - Vicente Monsalve Dolz
- Department of Anesthesiology Critical Care and Pain Management; General University Hospital; Valencia Spain
- Multidisciplinary Pain Management Department; General University Hospital; Valencia Spain
| | - Ana Minguez
- Department of Anesthesiology Critical Care and Pain Management; General University Hospital; Valencia Spain
- Multidisciplinary Pain Management Department; General University Hospital; Valencia Spain
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Abstract
Peripheral nerve stimulation (PNS) is likely the most diverse and rapidly expanding area of neuromodulation. Its expansion has become possible due to both technological and clinical advances in pain medicine. The first implantable systems were surgically placed. However, it is currently commonplace to use percutaneous leads, as this approach has become instrumental in its expansion. The first percutaneous peripheral nerve stimulators were reported in 1999. Cylindrical leads were implanted to stimulate the greater occipital nerve to manage intractable headache. It has been expanded into other individual nerves or nerve plexuses to treat neuropathic, visceral, cardiac, abdominal, low back and facial pain. The use of PNS in modulating organ function in treatment of syndromes such as epilepsy, incontinence and obesity with vagal, tibial and gastric stimulation is under extensive investigation. New technologies that allow easier and safer electrode placement are expected to further expand the uses of PNS. A noninvasive stimulation will open this treatment modality to more clinicians of varying backgrounds.
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Affiliation(s)
- Teodor Goroszeniuk
- Interventional Pain Management and Neuromodulation Practice, 18 Wimpole Street, London, W1G 8GD, UK,
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Dobias M, Michalek P, Neuzil P, Stritesky M, Johnston P. Interventional treatment of pain in refractory angina. A review. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2014; 158:518-27. [PMID: 24993738 DOI: 10.5507/bp.2014.028] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2014] [Accepted: 05/22/2014] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Refractory angina is characterized by repeated attacks of chest pain in patients on maximal anti-anginal pharmacotherapy, with a professional conscensus that further surgical or radiological revascularization would be futile. Refractory angina is a serious but relatively uncommon health problem, with a reported incidence of approximately 30 patients per million people/year. In this condition simply treating the associated pain alone is important as this can improve exercise tolerance and quality of life. METHODS An extensive literature search using five different medical databases was performed and from this, eighty-three papers were considered appropriate to include within this review. RESULTS AND CONCLUSION Available literature highlights several methods of interventional pain treatment, including spinal cord stimulation and video-assisted upper thoracic sympathectomy which can provide good analgesia whilst improving physical activities and quality of life. The positive effect of spinal cord stimulation on the intensity of pain and quality of life has been confirmed in nine randomized controlled trials. Other potential treatment methods include stellate ganglion blocks, insertion of thoracic epidural or spinal catheters and transcutaneous electrical nerve stimulation. These approaches however appear more useful for diagnostic purposes and perhaps as short-term treatment measures.
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Affiliation(s)
- Milos Dobias
- Department of Anaesthesia and Intensive Medicine, 1st Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czech Republic
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Henry TD, Satran D, Jolicoeur EM. Treatment of refractory angina in patients not suitable for revascularization. Nat Rev Cardiol 2013; 11:78-95. [DOI: 10.1038/nrcardio.2013.200] [Citation(s) in RCA: 100] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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De Decker K, Beese U, Staal MJ, Dejongste MJL. Electrical neuromodulation for patients with cardiac diseases. Neth Heart J 2013. [PMID: 23197049 DOI: 10.1007/s12471-012-0356-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
In this review we discuss the position of electrical neuromodulation as a safe and reversible adjuvant therapy for treatment of patients with chronic cardiac diseases who have become refractory to conventional strategies. In patients with chronic refractory angina, electrical neuromodulation, independent of the applied modality, has shown to reduce complaints of angina, to enhance exercise capacity, to improve quality of life and to employ anti-ischaemic effects. To date, electrical neuromodulation seems to be one of the best adjuvant therapies for these patients. In addition, neuromodulation in the treatment of heart failure and resistant arrhythmias is the subject of several ongoing studies.
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Affiliation(s)
- K De Decker
- University Medical Centre of Groningen and University of Groningen, 9700 RB, Groningen, the Netherlands
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Taira T, Goto S. Validation and perspectives of neuromodulation in Japan. Neurol Med Chir (Tokyo) 2012; 52:457-62. [PMID: 22850492 DOI: 10.2176/nmc.52.457] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Neuromodulation in functional neurosurgery is closely related to the development and availability of devices such as implantable electric stimulators and pumps. All such devices used in Japan are developed and made in foreign countries, and no made-in-Japan device exists. Introduction and approval by the government took many years for most devices, during which time many patients had to continue to live in our medically conservative country. The history of neuromodulation is summarized in Japan and the problems surrounding neuromodulation pointed out. Everyone has to aware of such circumstances and make every effort to improve the internationally unusual situation of neuromodulation in Japan. Otherwise, Japan will become a medically isolated country in the near future.
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Affiliation(s)
- Takaomi Taira
- Department of Neurosurgery, Tokyo Women's Medical University, Tokyo, Japan.
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Lanza GA, Barone L, Di Monaco A. Effect of Spinal Cord Stimulation in Patients With Refractory Angina: Evidence From Observational Studies. Neuromodulation 2012; 15:542-9; disdcussion 549. [DOI: 10.1111/j.1525-1403.2012.00430.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Levy RM. Differentiating the leaves from the branches in the tree of neuromodulation: the state of peripheral nerve field stimulation. Neuromodulation 2012; 14:201-5. [PMID: 21992239 DOI: 10.1111/j.1525-1403.2011.00359.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Goroszeniuk T, Pang D, Kothari S. Peripheral Neuromodulation for Angina: Gathering Momentum. Neuromodulation 2011; 14:486. [DOI: 10.1111/j.1525-1403.2011.00402.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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