What Alternative Therapies Are There For Patients With Refractory Angina?

— -- Question: What alternative therapies are there for patients with refractory angina (angina that does not respond to the usual medications)?

Answer: There are multiple ways to treat patients who have angina. One is medication. One is angioplasty with a stent usually. And the last is bypass surgery. And they're all highly effective in relieving symptoms.

So generally, we treat patients initially with medical therapy and see how they do. If that fails to control symptoms, then an angioplasty is frequently the next step, or bypass surgery if there are many severe blockages. And then patients generally do very well after that.

However, there is a small percentage of patients who continue to have angina or redevelop angina and whom bypass surgery or angioplasty are no longer available for them because the blockages are not reachable by a bypass or reachable by a balloon catheter to open up the blockage.

So for those patients, there are some newer ways to treat the problem that seem to be very interesting. There are new medications that are coming along. One of them has been recently released that seems to be effective in this group of patients. And there are a number of agents that are available in Europe that are coming that will be available in the United States to treat patents just like this.

In addition, there are a number of other techniques that can be used. External counterpulsation, which is a technique of treatments that occur about three times a week that compress the arteries and push the blood back to the heart. It seems to stimulate the heart to develop its own blood vessels.

There are also treatments with experimental treatments with cells in cell therapy or drugs that promote new blood vessels to be grown in the heart called angiogenesis. And there is a technique that is used widely in Europe that I think is gaining some interest in the United States called spinal cord stimulation, which is like a pacemaker that helps relieve the anginal pain.

So these are both mechanical ways of doing it, technical ways of doing it, and medication ways of treating those patients who don't respond to the traditional three ways that we treat patients with angina.

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