Combining pulsed radiofrequency and low-temperature plasma ablation for refractory cervicogenic angina after percutaneous coronary intervention: a case report.

Cervicogenic angina is a frequently overlooked non-cardiac chest pain syndrome whose clinical manifestations closely resemble those of true cardiac angina, and conventional anti-anginal medications as well as coronary interventions often yield unsatisfactory results. This report describes a 61-year-old male patient who presented with recurrent precordial pain, chest tightness, dyspnea, and numbness of the neck, shoulders and upper extremities for one year. The patient was initially diagnosed with coronary artery disease and underwent coronary intervention, but symptoms recurred shortly after the procedure and sublingual nitroglycerin was ineffective. After cardiac causes were ruled out through specialized cardiac examinations, physical examination revealed positive paravertebral tenderness and signs of nerve root compression. Cervical magnetic resonance imaging demonstrated disc herniation at C5-C7 with nerve root compression, leading to a final diagnosis of cervicogenic angina. The patient underwent ultrasound-guided pulsed radiofrequency of the cervical nerve roots and cervical sympathetic nerve combined with low-temperature plasma ablation of the cervical facet joints, followed by postoperative adjunctive treatment with duloxetine. Neck-shoulder pain and precordial discomfort improved markedly, with the visual analog scale score decreasing from 7 preoperatively to 0 at the 3-month follow-up; Cervical range of motion markedly improved; precordial pain, chest tightness, and dyspnea resolved completely without recurrence, and sleep quality improved significantly. This case suggests that cervicogenic angina should be strongly suspected in patients with recurrent chest pain after a standard cardiac work-up has excluded a cardiac origin. Ultrasound-guided radiofrequency intervention is safe and effective, providing a reliable minimally invasive treatment strategy for this easily missed condition and deserves wider clinical application.