Although vasospastic angina (VSA) is usually controlled by medications, refractory or lethal cases are occasionally encountered. We performed bilateral endoscopic thoracic sympathectomy (ETS) in 5 male patients with refractory VSA. Prior to ETS, stellate ganglion blockade was performed in 4 patients to reduce VSA attacks and to confirm the effect of sympathetic blockade. Under endoscopic guidance, the second to fourth thoracic sympathetic ganglia were ablated with a YAG-laser. No patient had complications after ETS, including major sweating abnormalities. In 4 of 5 patients, ETS relieved all VSA symptoms. ST-segment elevation often detected before ETS was absent on repeated ambulatory 24-h Holter monitoring after ETS. ETS is an effective strategy for the treatment of refractory VSA. © 2008.
Yoshida, K., Inoue, T., Hirakawa, N., & Node, K. (2008). Endoscopic thoracic sympathectomy as a novel strategy for vasospastic angina refractory to medical treatments. Journal of Cardiology, 52(1), 49–52. https://doi.org/10.1016/j.jjcc.2008.04.002