Chronic refractory angina pectoris treated by bilateral
stereotactic radiosurgical stellate ganglion ablation:
first-in-man case report

J 2021

Chronic refractory angina pectoris treated by bilateral stereotactic radiosurgical stellate ganglion ablation: first-in-man case report

HUDEC, Miroslav, Otakar JIRAVSKÝ, Radim ŠPAČEK, Radek NEUWIRTH, Lukas KNYBEL et. al.

Základní údaje

Originální název

Chronic refractory angina pectoris treated by bilateral stereotactic radiosurgical stellate ganglion ablation: first-in-man case report

Autoři

HUDEC, Miroslav (203 Česká republika, domácí), Otakar JIRAVSKÝ (203 Česká republika, domácí), Radim ŠPAČEK (203 Česká republika), Radek NEUWIRTH (203 Česká republika, domácí), Lukas KNYBEL (203 Česká republika), Libor ŠKŇOUŘIL (203 Česká republika), Jakub CVEK (203 Česká republika) a Roman MIKLÍK (203 Česká republika, garant)

Vydání

European Heart Journal - Case Reports, Oxford, OXFORD UNIV PRESS, 2021, 2514-2119

Další údaje

Jazyk

angličtina

Typ výsledku

Článek v odborném periodiku

Obor

30201 Cardiac and Cardiovascular systems

Stát vydavatele

Velká Británie a Severní Irsko

Utajení

není předmětem státního či obchodního tajemství

Odkazy

URL

Kód RIV

RIV/00216224:14110/21:00122283

Organizační jednotka

Lékařská fakulta

DOI

http://dx.doi.org/10.1093/ehjcr/ytab184

UT WoS

000696197100040

Klíčová slova anglicky

Upper thoracic sympathetic system; Stellate ganglion blockade; Refractory angina; Stereotactic radiosurgery; Case report

Štítky

14110211, rivok

Příznaky

Mezinárodní význam, Recenzováno

Změněno: 29. 3. 2022 12:52, Mgr. Tereza Miškechová

Anotace

V originále

Background Refractory angina pectoris (AP) significantly impairs quality of life in patients with chronic coronary syndrome. Several minimally invasive methods (coronary sinus reducer, cell therapy, laser or shockwave revascularization, and spinal cord stimulation) or non-invasive methods (external counterpulzation) have been studied. However, their routine clinical use has not been widely implemented. Surgical or endoscopic sympathectomy is feasible for permanently relieving angina, but is often contraindicated due to the extent of complications associated with it. Neuromodulation by anaesthetic blockade of the left-sided stellate ganglion (SG) has been shown to relieve angina for days or weeks. To provide a long-term anti-anginal effect, novel pharmacological (phenol-based) or radiofrequency ablation techniques have been individually used to permanently destroy sympathetic pathways. Case summary We describe a first-in-man use of stereotactic radiosurgical SG ablation using a linear accelerator (CyberKnife) in a heart failure patient after myocardial infarction with chronic refractory AP. Repeated anaesthetic SG blockade in this patient resulted in a significant, but only short-term, clinical improvement. The left, and subsequently the right, SG was ablated by targeted irradiation. During the 1-year follow-up, the patient remained without angina. We did not observe any clinically relevant early or late complications. Atrial fibrillation that developed 2 months after the second procedure was deemed to be associated with a natural progression of co-existing heart failure. Discussion We conclude that stereotactic radiosurgical SG ablation has the potential to become a minimally invasive and low-risk procedure to treat refractory angina patients. However, this procedure needs to be evaluated in larger patient populations.

Citovat

HUDEC, Miroslav, Otakar JIRAVSKÝ, Radim ŠPAČEK, Radek NEUWIRTH, Lukas KNYBEL, Libor ŠKŇOUŘIL, Jakub CVEK a Roman MIKLÍK. Chronic refractory angina pectoris treated by bilateral stereotactic radiosurgical stellate ganglion ablation: first-in-man case report. European Heart Journal - Case Reports. Oxford: OXFORD UNIV PRESS, 2021, roč. 5, č. 8, s. 1-10. ISSN 2514-2119. Dostupné z: https://dx.doi.org/10.1093/ehjcr/ytab184.

@article{1790397,
   author = {Hudec, Miroslav and Jiravský, Otakar and Špaček, Radim and Neuwirth, Radek and Knybel, Lukas and Škňouřil, Libor and Cvek, Jakub and Miklík, Roman},
   article_location = {Oxford},
   article_number = {8},
   doi = {http://dx.doi.org/10.1093/ehjcr/ytab184},
   keywords = {Upper thoracic sympathetic system; Stellate ganglion blockade; Refractory angina; Stereotactic radiosurgery; Case report},
   language = {eng},
   issn = {2514-2119},
   journal = {European Heart Journal - Case Reports},
   title = {Chronic refractory angina pectoris treated by bilateral stereotactic radiosurgical stellate ganglion ablation: first-in-man case report},
   url = {https://watermark.silverchair.com/ytab184.pdf?token=AQECAHi208BE49Ooan9kkhW_Ercy7Dm3ZL_9Cf3qfKAc485ysgAAAvEwggLtBgkqhkiG9w0BBwagggLeMIIC2gIBADCCAtMGCSqGSIb3DQEHATAeBglghkgBZQMEAS4wEQQMVlTIkS_AXIjCwvo_AgEQgIICpJYRYrCW6bXD4VeQKo73HBeMJhEKIaaT__MPU51FixcXWh},
   volume = {5},
   year = {2021}
}

TY  - JOUR
ID  - 1790397
AU  - Hudec, Miroslav - Jiravský, Otakar - Špaček, Radim - Neuwirth, Radek - Knybel, Lukas - Škňouřil, Libor - Cvek, Jakub - Miklík, Roman
PY  - 2021
TI  - Chronic refractory angina pectoris treated by bilateral stereotactic radiosurgical stellate ganglion ablation: first-in-man case report
JF  - European Heart Journal - Case Reports
VL  - 5
IS  - 8
SP  - 1-10
EP  - 1-10
PB  - OXFORD UNIV PRESS
SN  - 25142119
KW  - Upper thoracic sympathetic system
KW  - Stellate ganglion blockade
KW  - Refractory angina
KW  - Stereotactic radiosurgery
KW  - Case report
UR  - https://watermark.silverchair.com/ytab184.pdf?token=AQECAHi208BE49Ooan9kkhW_Ercy7Dm3ZL_9Cf3qfKAc485ysgAAAvEwggLtBgkqhkiG9w0BBwagggLeMIIC2gIBADCCAtMGCSqGSIb3DQEHATAeBglghkgBZQMEAS4wEQQMVlTIkS_AXIjCwvo_AgEQgIICpJYRYrCW6bXD4VeQKo73HBeMJhEKIaaT__MPU51FixcXWh
N2  - Background Refractory angina pectoris (AP) significantly impairs quality of life in patients with chronic coronary syndrome. Several minimally invasive methods (coronary sinus reducer, cell therapy, laser or shockwave revascularization, and spinal cord stimulation) or non-invasive methods (external counterpulzation) have been studied. However, their routine clinical use has not been widely implemented. Surgical or endoscopic sympathectomy is feasible for permanently relieving angina, but is often contraindicated due to the extent of complications associated with it. Neuromodulation by anaesthetic blockade of the left-sided stellate ganglion (SG) has been shown to relieve angina for days or weeks. To provide a long-term anti-anginal effect, novel pharmacological (phenol-based) or radiofrequency ablation techniques have been individually used to permanently destroy sympathetic pathways. Case summary We describe a first-in-man use of stereotactic radiosurgical SG ablation using a linear accelerator (CyberKnife) in a heart failure patient after myocardial infarction with chronic refractory AP. Repeated anaesthetic SG blockade in this patient resulted in a significant, but only short-term, clinical improvement. The left, and subsequently the right, SG was ablated by targeted irradiation. During the 1-year follow-up, the patient remained without angina. We did not observe any clinically relevant early or late complications. Atrial fibrillation that developed 2 months after the second procedure was deemed to be associated with a natural progression of co-existing heart failure. Discussion We conclude that stereotactic radiosurgical SG ablation has the potential to become a minimally invasive and low-risk procedure to treat refractory angina patients. However, this procedure needs to be evaluated in larger patient populations.
ER  -

HUDEC, Miroslav, Otakar JIRAVSKÝ, Radim ŠPAČEK, Radek NEUWIRTH, Lukas KNYBEL, Libor ŠKŇOUŘIL, Jakub CVEK a Roman MIKLÍK. Chronic refractory angina pectoris treated by bilateral stereotactic radiosurgical stellate ganglion ablation: first-in-man case report. \textit{European Heart Journal - Case Reports}. Oxford: OXFORD UNIV PRESS, 2021, roč.~5, č.~8, s.~1-10. ISSN~2514-2119. Dostupné z: https://dx.doi.org/10.1093/ehjcr/ytab184.

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