Publicado Jun 9, 2014


Google Scholar
Search GoogleScholar

Andrés Felipe Rojas Borda

Jairo Alejandro Aldana Bitar

Juan Carlos Acevedo González



La estimulación medular es considerada una opción eficaz de tratamiento en pacientes con diagnóstico de angina de pecho refractaria. A través del tiempo y con los resultados de los estudios clínicos, se ha posicionado como una alternativa segura que mejora la calidad de vida de los pacientes. En este artículo se revisa su historia, la técnica, su mecanismo de acción, los resultados de estudios clínicos y la utilización como alternativa en los pacientes con diagnóstico de angina refractaria.


angina de pecho, refractaria, tratamiento, Angina pectoris, refractory, treatment,

1. Abrams J. Clinical practice: Chronic stable angina. N Engl J Med. 2005;352(24): 2524-33.
2. Pakhomov SS, Hemingway H, Weston SA et al. Epidemiology of angina pectoris: role of natural language processing of the medical record. Am Heart J. 2007;153(4):666-73.
3. Mannheimer C, Camici P, Chester MR, et al. The problem of chronic refractory angina; report from the ESC Joint Study Group on the Treatment of Refractory Angina. Eur Heart J. 2002;23(5):355-70.
4. Aguiar-Souto P, González-Juanatey JR. Angina crónica estable: fisiopatología y formas de manifestación clínica. Rev Esp Cardiol Supl. 2010;10 Suppl B:S11-21.
5. González-Darder JM, Canela P, González-Martínez V. High cervical spinal cord stimulation for unstable angina pectoris. Stereotact Funct Neurosurg. 1991; 56(1):20-7.
6. Lee SH, Jeong HJ, Jeong SH et al. Spinal cord stimulation for refractory angina pectoris —a case report—. Korean J Pain. 2012;25(2):121-5.
7. Sanderson JE, Brooksby P, Waterhouse D et al. Epidural spinal electrical stimulation for severe angina: A study of its effect on symptoms, exercise tolerance and degree of ischemia. Eur Heart J. 1992; 13:628-33.
8. Stillings D. The first use of electricity for pain treatment. Medtronic Archive on Electro-Stimulation; 1971.
9. Pocock SN. Electricity in medicine. Proceedings of the IEE-Part II: Power Engineering. 1954;101(84):629-38.
10. Williams RE. Electricity in medicine. Electrical Engineering. 1938;57(6): 237-44.
11. Melzack R, Wall PD. Pain mechanisms: a new theory. Science. 1965;150(3699): 971-9.
12. Murphy DF, Giles KE. Dorsal column stimulation for pain relief from intractable angina pectoris. Pain. 1987;28(3):365-8.
13. Morgan JP. The first reported case of electrical stimulation of the human brain. J Hist Med Allied Sci. 1982;37(1):51-64.
14. Shealy CN, Mortimer JT, Reswick JB. Electrical inhibition of pain by stimulation of the dorsal columns: preliminary clinical report. Anesth Analg. 1967;46(4):489-91.
15. Meyerson BA, Linderoth B. Mode of action of spinal cord stimulation in neuropathic pain. J Pain Symptom Manage. 2006;31:6-12.
16. Cui JG, O’Connor WT, Ungerstedt U et al. Spinal cord stimulation attenuates augmented dorsal horn release of excitatory amino acids in mononeuropathy via a GABAergic mechanism. Pain. 1997;73:87-95.
17. Stiller CO, Cui J-G, O’Connor WT et al. Release of GABA in the dorsal horn and suppression of tactile allodynia by spinal cord stimulation in mononeuropathic rats. Neurosurgery. 1996;39:367-75.
18. Song ZY, Ultenius C, Schechtmann G et al. Downregulation of M4 but not M2 muscarinic receptors in the dorsal horn after peripheral nerve injury relates to responsiveness to SCS. Abstract of the Second International Congress on Neuropathic Pain, Berlin; June 2007. Eur J Pain. 2007;11 Suppl 1:175.
19. Michaelis M. Coupling of sympathetic and somatosensory neurons following nerve injury: mechanisms and potential significance for the generation of pain. En: Devor M, Rowbotham MC, Wiesenfeld Z, editors. Progress in pain research and management, vol. 16. Seattle: IASP Press; 1999. p. 645-56.
20. Wang XL, Zhang HM, Li DP, Chen SR, Pan HL. Dynamic regulation of glycinergic input to spinal dorsal horn neurones by muscarinic receptor subtypes in rats. J Physiol 2006;571:403-13.
21. Mannheimer C, Eliasson T, Andersson B et al. Effects of spinal cord stimulation in angina pectoris induced by pacing and possible mechanisms of action. BMJ. 1993;307(6902):477-80.
22. Eckert S, Horstkotte D. Management of angina pectoris: the role of spinal cordstimulation. Am J Cardiovasc Drugs. 2009;9(1):17-28.
23. Oldroyd KG, Harvey K, Gray CE, Beastall GH, Cobbe SM. Beta endorphin release in patients after spontaneous and provoked acute myocardial ischaemia. Br Heart J. 1992;67(3):230-5.
24. Robertson RM, Bernard Y, Robertson D. Arterial and coronary sinus catecholamines in the course of spontaneous coronary artery spasm. Am Heart J. 1983;105(6):901-6.
25. Esler M, Jennings G, Korner P, Blombery P, Sacharias N, Leonard P. Measurement of total and organ-specific norepinephrine kinetics in humans. Am J Physiol. 1984;247(1 Pt 1):E21-8.
26. Foreman RD, Linderoth B, Ardell JL et al. Modulation of intrinsic cardiac neurons by spinal cord stimulation: implications for its therapeutic use in angina pectoris. Cardiovasc Res. 2000;47(2):367-75.
27. De landsheere C, Mannheimer C, Habets A et al. Effect of spinal cord stimulation on regional myocardial perfusion assessed by positron emission tomography. Am J Cardiol. 1992;69(14):1143-9.
28. Hautvast RW, Blanksma PK, DeJongste MJL, et al. Effects of spinal cord stimulation onmyocardial blood flow assessed by positron emission tomography in patients with refractory angina pectoris. Am J Cardiol. 1996;77:462-7.
29. Diedrichs H, Weber M, Koulousakis A et al. Improved myocardial blood flow in patients with intractable angina pectoris through spinal cord stimulation. J Nucl Cardiol. 2004;11 Suppl 4:25S.
30. Kujacic V, Eliasson T, Mannheimer C et al. Assessment of the influence of spinal cord stimulation on left ventricular function in patients with server angina pectoris: an echocardiographic study. Eur Heart J. 1993;14:1238-44.
31. Mannheimer C, Eliasson T, Augustinsson LE et al. Electrical stimulation versus coronary artery bypass surgery in severe angina pectoris: the ESBY study. Circulation. 1998;97(12):1157-63.
32. Lanza GA, Grimaldi R, Greco S et al. Spinal cord stimulation for the treatment of refractory angina pectoris: a multicenter randomized single-blind study (the SCSITA trial). Pain. 2011;152(1):45-52.
33. Zipes DP, Svorkdal N, Berman D et al. Spinal cord stimulation therapy for patients with refractory angina who are not candidates for revascularization. Neuromodulation. 2012;15(6):550-8.
34. Börjesson M, Andrell P, Lundberg D, Mannheimer C. Spinal cord stimulation in severe angina pectoris--a systematic review based on the Swedish Council on Technology assessment in health care report on long-standing pain. Pain. 2008;140(3):501-8.
35. Fumero A, Lapenna E, Taramasso M, Alfieri O. [Spinal cord stimulation for refractory chronic angina pectoris: 100 patients treated in our 12-year experience]. G Ital Cardiol (Rome). 2011;12(9):599-605.
36. Meyerson BA, Linderoth B. Mode of action of spinal cord stimulation in neuropathic pain. J Pain Symptom Manage. 2006;31(4 Suppl):S6-12.
37. Linderoth B, Foreman R. Mechanisms of spinal cord stimulation in painful syndromes. Role of animal models. Pain Med 2006;7(Suppl 1):14-26.
38. Sindou MP, Mertens P, Bendavid U et al. Predictive value of somatosensory evoked potentials for long-lasting pain practical use for patient selection. Neurosurgery. 2003;52(6):1374-83.
39. García-Moll M, Serra R, García-Moll X. Tratamiento de la angina refractaria con electroestimulación medular: resultados del seguimiento a largo plazo. Rev Esp Cardiol. 2000;53:321-6.
40. Simpson BA, Bassett G, Davies K et al. Cervical spinal cord stimulation for pain: a report on 41 patients. Neuromodulation. 2003;6(1):20-6.
41. González-Darder JM, González-Martínez V, Canela P, Hernández R. Estimulación eléctrica medular en la angina rebelde e incapacitante: protocolo y resultados a largo plazo. Neurocirugía. 1993;4:305-11.
42. Mukherjee D. Management of refractory angina in the contemporary era. Eur Heart J. 2013;34(34):2655-7.
43. Tenvaarwerk IA, Jessurun GA, Dejongste MJ et al. Clinical outcome of patients treated with spinal cord stimulation for therapeutically refractory angina pectoris. The Working Group on Neurocardiology. Heart. 1999;82(1):82-8.
44. Hautvast RW, Dejongste MJ, Staal MJ et al. Spinal cord stimulation in chronic intractable angina pectoris: a randomized, controlled efficacy study. Am Heart J. 1998;136(6):1114-20.
45. Augustinsson LE. Spinal cord electrical stimulation in severe angina pectoris: surgical technique, intraoperative physiology, complications, and side effects. Pacing Clin Electrophysiol. 1989;12(4 Pt 2):693-4.
46. Lind G, Meyerson BA, Winter J, Linderoth B. Implantation of laminotomy electrodes for spinal cord stimulation in spinal anesthesia with intraoperative dorsal column activation. Neurosurgery. 2003;53(5):1150-3.
47. Ekre O, Norrsell H, Währborg P et al. Temporary cessation of spinal cord stimulation in angina pectoris-effects on symptoms and evaluation of long-term effect determinants. Coron Artery Dis. 2003;14(4):323-7.
48. North RB, Kidd DH, et al. Prognostic value of psychological testing in patients undergoing spinal cord stimulation: a prospective study. Neurosurgery. 1996;39(2):301-10; discussion 310-1.
49. Dumoulin K, Devulder J, De Laat M et al. A psychoanalytic investigation to improve the success rate of spinal cord stimulation as a treatment for chronic failed back surgery syndrome. Clin J Pain. 1996;12(1):43-9.
50. North RB, Kidd DH, Wimberly RL, Edwin D. Prognostic value of psychological testing in patients undergoing spinal cord stimulation: a prospective study. Neurosurgery. 1996;39(2):301-10.
Cómo citar
Rojas Borda, A. F., Aldana Bitar, J. A., & Acevedo González, J. C. (2014). Estimulación medular en el tratamiento de la angina refractaria. Universitas Medica, 55(3), 311–327.
Artículos de revisión

Artículos más leídos del mismo autor/a

1 2 3 > >>