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.

Basic information

Original name

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

Authors

HUDEC, Miroslav (203 Czech Republic, belonging to the institution), Otakar JIRAVSKÝ (203 Czech Republic, belonging to the institution), Radim ŠPAČEK (203 Czech Republic), Radek NEUWIRTH (203 Czech Republic, belonging to the institution), Lukas KNYBEL (203 Czech Republic), Libor ŠKŇOUŘIL (203 Czech Republic), Jakub CVEK (203 Czech Republic) and Roman MIKLÍK (203 Czech Republic, guarantor)

Edition

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

Other information

Language

English

Type of outcome

Článek v odborném periodiku

Field of Study

30201 Cardiac and Cardiovascular systems

Country of publisher

United Kingdom of Great Britain and Northern Ireland

Confidentiality degree

není předmětem státního či obchodního tajemství

References:

URL

RIV identification code

RIV/00216224:14110/21:00122283

Organization unit

Faculty of Medicine

DOI

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

UT WoS

000696197100040

Keywords in English

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

Abstract

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 and 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, vol. 5, No 8, p. 1-10. ISSN 2514-2119. Available from: 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 and 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, vol.~5, No~8, p.~1-10. ISSN~2514-2119. Available from: https://dx.doi.org/10.1093/ehjcr/ytab184.

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