Nonconventional therapeutic modalities in refractory angina pectoris

Despite sophisticated conventional medical treatment and the continued development and improvement of coronary revascularization modalities in recent years, a significant number of patients still suffer from refractory angina pectoris and cannot be successfully managed. Advances in therapeutic options have led to an increase in the average of life expectancy even in such no-option patients. Management of these patients is a challenging problem because most of them have already undergone multiple coronary interventions or surgeries and therefore are not suitable candidates for further procedures. In this situation, cardiologists who frequently face the patients are limited in their decision making when all therapeutic methods have been exhausted. The aim of this review article was to draw attention to the novel therapeutic strategies currently available for this condition, including nonconventional medical treatment, improving myocardial perfusion, neuromodulation, new vessel formation and eventually heart transplantation. Unfortunately, these therapies have only a complementary role because of inadequate experience. Therefore, maximal conventional treatment along with these options should be used on an individual basis.