P.149 Spinal Cord Stimulation for Refractory Angina

Background: Refractory angina is defined as a chronic condition characterized by the presence of angina due to coronary insufficiency which cannot be controlled by a combination of medical therapy, angioplasty and coronary bypass surgery. Prevalence in the United States is estimated to be between 300,000-900,000. Spinal cord stimulation for refractory angina pain relief was first described in 1987 but is still not widely used in North America. We report our experience with this treatment. Methods: A retrospective review of patients referred to the St Pauls Hospital neuromodulation program for consideration of SCS for refractory angina was conducted. Patients underwent implantation using a either a two stage approach (percutaneous or permanent lead trial followed by full system implantation) or full system implantation. Results: Bewtween 2004-2020 36 patients underwent full system implantation (2 patients failed the trial and were not implanted). Of the 36 patients undergoing full system implantation, 33 (92%) experienced significant reduction of angina, increased exercise tolerance and/or medication reduction and were considered successful implantation. Most common lead placement location was at C7 T1. Conclusions: Spinal cord stimulation is an effective therapy for patients suffering from crippling angina pain despite medical optimization.