{
  "abstract": "Application for ESRA Abstract Prizes:Background and Aims Refractory angina refers to chest pain that persists despite optimal medical management and is not amenable to revascularization. Microvascular angina represents a particularly challenging and frequently underdiagnosed subtype. Spinal cord stimulation (SCS) is a minimally invasive, reversible neuromodulatory technique with demonstrated benefit in selected patients. We report the first case in our center of microvascular angina successfully managed with SCS after failure of all conventional therapies.Methods A 55-year-old man with microvascular angina and prior coronary revascularizations—including multivessel stenting and coronary sinus Reducer implantation—presented with persistent CCS class IV angina despite optimal pharmacologic treatment. He required frequent emergency visits and hospitalizations for recurrent chest pain, with partial relief from intravenous nitrates and transdermal opioids. Following a favorable home-based TENS trial, SCS was indicated. Under local anesthesia and sedation, an epidural lead was placed at L2-L3 and advanced to C7 under fluoroscopic guidance. A subcutaneous pulse generator was implanted.Results The postoperative course was uneventful. Minor programming adjustments were needed to optimize stimulation. The patient reported sustained improvement in anginal symptoms, experiencing fewer and less intense episodes. He discontinued transdermal opioids and reduced overall medication use. At follow-up, his functional capacity and independence had markedly improved. No complications were observed, and symptom control remained stable.Abstract P281 Figure 1CT scan showing spinal cord stimulator lead from lumbar to cervical spine, with pulse generator in right lower quadrantConclusions SCS appears to be a safe and effective therapeutic option in selected cases of refractory microvascular angina. This case highlights the potential role of neuromodulation within a multidisciplinary approach to cardiovascular pain management.",
  "authors": [
    {
      "affiliations": [
        "Anesthesiology, Hospital Mutua de Terrassa, Barcelona, Spain"
      ],
      "name": "Georgina Simó Pons"
    },
    {
      "affiliations": [
        "Anesthesiology, Hospital Mutua de Terrassa, Terrassa, Spain"
      ],
      "name": "Miriam De la Maza Segovia"
    },
    {
      "affiliations": [
        "Anesthesiology, Hospital Mutua de Terrassa, Terrassa, Spain"
      ],
      "name": "Jean Louis Clave"
    }
  ],
  "title": "P281 Spinal cord stimulation for microvascular angina unresponsive to standard therapies: a case report",
  "uid": "3455e3f2-1dc8-539e-9c96-54aff14c3771"
}