“The elephant is gone”: Spinal cord stimulation for therapy‑refractory angina pectoris: A case report

Öz

Refractory angina pectoris (RAP) represents the group that continues to experience recurrent angina attacks despite optimal treatment, lifestyle modifications, and implemented revascularization options. This condition, called RAP, results in significant deterioration in quality of life and a high healthcare burden. Previous studies have reported that spinal cord stimulation (SCS) therapy provides significant improvement in symptoms in patients with RAP, reduces the frequency of angina attacks, reduces the need for antianginal medication, and improves quality of life. Our case demonstrates the potential benefit of spinal cord stimulation in carefully selected patients with refractory RAP. After treatment, our patient achieved sustained symptomatic relief, functional gains, and reduced nitrate dependence. This case provides a good example of an innovative and promising treatment approach for patients with RAP, whose options are limited due to the inadequacy or inapplicability of conventional treatment methods. In the future, cardiologists' adoption of SCS as a component of their treatment strategies and their application of this approach in a multidisciplinary framework together with neurosurgeons and interventional pain specialists will be a decisive factor in SCS gaining a strong place in RAP treatment guidelines.

Anahtar Kelimeler

• Angina pectoris
• neuromodulation
• refractory angina pectoris
• spinal cord stimulation

"Fil gitti": Tedaviye dirençli angina pektoris için omurilik stimülasyonu: Bir olgu sunumu

Öz

Refrakter anjina pektoris (RAP) optimal tedavi, yaşam tarzı değişikliği ve uygulanmış revaskülarizasyon seçeneklerine rağmen tekrarlayan anjina atakları yaşamaya devam eden grubu temsil etmektedir. Bu duruma RAP denilmekte ve yaşam kalitesinde ciddi bozulma ve yüksek sağlık hizmeti yüküne neden olmakla sonuçlanmaktadır. Daha önce yapılan çalışmalar, omurilik stimülasyonu (SCS) tedavisinin RAP tanılı hastaların semptomlarında belirgin düzelme sağladığını, anjina ataklarının sıklığını düşürdüğünü, antianjinal ilaç kullanım gereksinimini azalttığını ve hastaların yaşam kalitesini artırdığını bildirmektedir. Vakamız, dirençli RAP tanılı iyi seçilmiş hastalarda omurilik stimülasyonunun potansiyel faydasını göstermektedir. Hastamız, tedavi sonrası kalıcı semptomatik rahatlama, işlevsel kazanımlar elde etmiş ve nitratlara olan bağımlılığı azaltmıştır. Bu vakamız, klasik tedavi yöntemlerinin yetersiz olması veya uygulanabilir olmaması nedeniyle sınırlı seçeneklere sahip olan RAP tanılı hastalar için yenilikçi ve umut verici bir tedavi yaklaşımına güzel bir örnek olmaktadır. Gelecekte kardiyologların SCS’yi tedavi stratejilerinin bir bileşeni olarak benimsemesi ve bu yaklaşımı beyin cerrahları ile girişimsel ağrı uzmanlarıyla birlikte multidisipliner bir çerçevede uygulamaları, SCS’nin RAP tedavi kılavuzlarında güçlüce yer bulmasında belirleyici bir etken olacaktır.

Anahtar Kelimeler

• Angina pektoris
• nöromodülasyon
• omurilik stimülasyonu
• refrakter angina pektoris

Kaynakça

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