[Epidural spinal cord stimulation in the treatment of refractory angina pectoris. Mechanisms of action, clinical results and current indications]. / La stimolazione spinale epidurale nel trattamento dell'angina pectoris refrattaria. Meccanismi d'azione, risultati clinici ed indicazioni attuali.

The spinal cord stimulation (SCS) is an antalgic technique which has been used since 1967 for the treatment of several painful syndromes. More recently it was employed in cardiology to treat refractory angina, not suitable for revascularization. Despite the fact that published results on this subject have reported small, non-homogeneous series, and that the mechanisms of action are not completely understood, we can affirm according to the analysis of the literature and our own experience that SCS causes improvement in quality of life, reduction in frequency of angina attacks and reduced consumption of rapid-action nitrates. There is also evidence that electrical stimulation has a definite anti-ischemic effect, as revealed by increased work capacity, improved lactate metabolism and reduced downward slope of ST segment at comparable maximum work load. In expert hands SCS implantation is associated with relatively low frequency of complications, whose incidence is greatly reduced if the main contraindications are respected, particularly in patients receiving anticoagulants or with an infection.