Despite sophisticated medical and surgical procedures,including percutaneous endovascular methods,a large number of patients suffer from chronic refractory angina pectoris.Refractory angina pectoris is a chronic condition characterized by the presence of severe chest pain,caused by coronary artery disease (CAD),which cannot be relieved by coronary intervention,coronary artery bypass grafting,and optimal medical treatment.Improvement of pain relief in this category of patients requires the use of adjuvant therapies,of which spinal cord stimulation(SCS)seems to be most promising.Controlled studies suggest that in patients with chronic refractory angina,SCS provides symptomatic relief that is equivalent to that provided by surgical or endovascular reperfusion procedures,but with a lower rate of complications and rehospitalization.SCS is today considered as first-line treatment of refractory angina pectoris,by the European society of Cardiology,with an anti-ischemic effect.