Refractory angina is a chronic condition defined as persistent, disabling chest pain due to myocardial ischaemia that occurs despite maximal optimal medical therapy, when revascularisation options (PCI or CABG) are no longer suitable or effective.
Refractory angina usually occurs due to diffuse or advanced coronary artery disease not amenable to stenting or bypass, microvascular dysfunction (small vessel disease), coronary endothelial dysfunction, or previous multiple revascularisation procedures with persistent ischaemia.
Management is focused on symptom control and improving quality of life rather than cure. Following optimal medical management and lifestyle modification, certain newer advanced pain management strategies have been recommended.
At Barts, I have been managing this condition along with a team of cardiologists, where we offer the following treatments, as deemed suitable:
a. Stem cell therapy
b. Coronary sinus reducer device
c. Neuromodulation (spinal cord stimulator in selected cases)
You can request your GP to arrange a named consultant referral to the Barts neuromodulation service to access these advanced treatment options if they are not available in your area.