Stereotactic radiosurgery as neuromodulation of refractory
angina: an initial case series

J 2025

Stereotactic radiosurgery as neuromodulation of refractory angina: an initial case series

CVEK, Jakub; Otakar JIRAVSKÝ; Lukas KNYBEL; Miroslav HUDEC; Radim SPACEK et. al.

Basic information

Original name

Stereotactic radiosurgery as neuromodulation of refractory angina: an initial case series

Authors

CVEK, Jakub (203 Czech Republic); Otakar JIRAVSKÝ (203 Czech Republic); Lukas KNYBEL (203 Czech Republic); Miroslav HUDEC (203 Czech Republic, belonging to the institution); Radim SPACEK (203 Czech Republic); Adrian REICHENBACH (203 Czech Republic); Jan HECKO (203 Czech Republic); Radek NEUWIRTH (203 Czech Republic, belonging to the institution) and Josef KAUTZNER (203 Czech Republic)

Edition

Radiation Oncology, LONDON, BMC, 2025, 1748-717X

Other information

Language

English

Type of outcome

Article in a journal

Field of Study

30201 Cardiac and Cardiovascular systems

Country of publisher

United Kingdom of Great Britain and Northern Ireland

Confidentiality degree

is not subject to a state or trade secret

References:

URL

Impact factor

Impact factor: 3.300 in 2023

Organization unit

Faculty of Medicine

DOI

http://dx.doi.org/10.1186/s13014-025-02608-9

UT WoS

001440953100001

EID Scopus

2-s2.0-105000044729

Keywords in English

Radiosurgery; Refractory angina

Abstract

V originále

BackgroundThis intervention pilot case series assessed 40-Gy stereotactic radiosurgery (SRS) neuromodulation applied to the bilateral stellate ganglion (SG) as a bailout procedure for patients with refractory angina pectoris (RAP).Materials and methodsThe local institutional review board approved this feasibility study. In three patients with RAP, after repeated good response, symptoms were temporarily relieved after anaesthetic blockade of the left SG under ultrasound guidance. Radiosurgical neuromodulation with a dose of 40 Gy in one fraction was used for more permanent pain control. When RAP recurred after the initial SRS, right-sided procedures were considered after a confirmed positive response to right SG anesthetic block.ResultsNo acute or late radiation-related toxicities were observed. Two patients (67%) responded to bilateral SRS (follow-up: 60 and 48 months, respectively). From baseline to 24 months, their average prescribed nitrate package count decreased from 5.5 to 0 and remained low. Daily emergency nitrates declined from 20 to 30 to 1-2 applications, and walking distance improved from 10 to 20 m to 200-400 m and remained stable. Quality of life as measured with the EQ-5D and all domains of the Seattle Angina Questionnaire improved. The third patient received only unilateral SRS, had a temporary improvement for 6 months before a return to baseline, and died after 42 months of follow-up.ConclusionsBilateral radiosurgical neuromodulation at 40 Gy appears to be feasible, safe, and effective as a bailout procedure for RAP.

Cite

CVEK, Jakub; Otakar JIRAVSKÝ; Lukas KNYBEL; Miroslav HUDEC; Radim SPACEK; Adrian REICHENBACH; Jan HECKO; Radek NEUWIRTH and Josef KAUTZNER. Stereotactic radiosurgery as neuromodulation of refractory angina: an initial case series. Radiation Oncology. LONDON: BMC, 2025, vol. 20, No 1, p. 1-10. ISSN 1748-717X. Available from: https://dx.doi.org/10.1186/s13014-025-02608-9.

@article{2488537,
   author = {Cvek, Jakub and Jiravský, Otakar and Knybel, Lukas and Hudec, Miroslav and Spacek, Radim and Reichenbach, Adrian and Hecko, Jan and Neuwirth, Radek and Kautzner, Josef},
   article_location = {LONDON},
   article_number = {1},
   doi = {http://dx.doi.org/10.1186/s13014-025-02608-9},
   keywords = {Radiosurgery; Refractory angina},
   language = {eng},
   issn = {1748-717X},
   journal = {Radiation Oncology},
   title = {Stereotactic radiosurgery as neuromodulation of refractory angina: an initial case series},
   url = {https://ro-journal.biomedcentral.com/articles/10.1186/s13014-025-02608-9},
   volume = {20},
   year = {2025}
}

TY  - JOUR
ID  - 2488537
AU  - Cvek, Jakub - Jiravský, Otakar - Knybel, Lukas - Hudec, Miroslav - Spacek, Radim - Reichenbach, Adrian - Hecko, Jan - Neuwirth, Radek - Kautzner, Josef
PY  - 2025
TI  - Stereotactic radiosurgery as neuromodulation of refractory angina: an initial case series
JF  - Radiation Oncology
VL  - 20
IS  - 1
SP  - 1-10
EP  - 1-10
PB  - BMC
SN  - 1748717X
KW  - Radiosurgery
KW  - Refractory angina
UR  - https://ro-journal.biomedcentral.com/articles/10.1186/s13014-025-02608-9
N2  - BackgroundThis intervention pilot case series assessed 40-Gy stereotactic radiosurgery (SRS) neuromodulation applied to the bilateral stellate ganglion (SG) as a bailout procedure for patients with refractory angina pectoris (RAP).Materials and methodsThe local institutional review board approved this feasibility study. In three patients with RAP, after repeated good response, symptoms were temporarily relieved after anaesthetic blockade of the left SG under ultrasound guidance. Radiosurgical neuromodulation with a dose of 40 Gy in one fraction was used for more permanent pain control. When RAP recurred after the initial SRS, right-sided procedures were considered after a confirmed positive response to right SG anesthetic block.ResultsNo acute or late radiation-related toxicities were observed. Two patients (67%) responded to bilateral SRS (follow-up: 60 and 48 months, respectively). From baseline to 24 months, their average prescribed nitrate package count decreased from 5.5 to 0 and remained low. Daily emergency nitrates declined from 20 to 30 to 1-2 applications, and walking distance improved from 10 to 20 m to 200-400 m and remained stable. Quality of life as measured with the EQ-5D and all domains of the Seattle Angina Questionnaire improved. The third patient received only unilateral SRS, had a temporary improvement for 6 months before a return to baseline, and died after 42 months of follow-up.ConclusionsBilateral radiosurgical neuromodulation at 40 Gy appears to be feasible, safe, and effective as a bailout procedure for RAP.
ER  -

CVEK, Jakub; Otakar JIRAVSKÝ; Lukas KNYBEL; Miroslav HUDEC; Radim SPACEK; Adrian REICHENBACH; Jan HECKO; Radek NEUWIRTH and Josef KAUTZNER. Stereotactic radiosurgery as neuromodulation of refractory angina: an initial case series. \textit{Radiation Oncology}. LONDON: BMC, 2025, vol.~20, No~1, p.~1-10. ISSN~1748-717X. Available from: https://dx.doi.org/10.1186/s13014-025-02608-9.

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