Closed-loop Spinal Cord Stimulation for Refractory Angina: A Case Report

Spinal cord stimulation (SCS) is an effective treatment for refractory angina pectoris (RAP).^{1, 2}  Despite development of paresthesia-free stimulation, RAP is often managed with tonic paresthesia-based stimulation.  One limitation of tonic, closed-loop SCS systems is intermittent unpleasant changes in stimulation intensity due to variation in distance between electrodes and the spinal cord.  Closed-loop systems adjust stimulation automatically thereby maintaining intensity within a therapeutic window, and subsequently offering an advantage in conditions responsive to tonic stimulation.^3,4,5