Electrical stimulation of collateral flow promising in acute stroke

Electrical stimulation of collateral flow promising in acute stroke

Natan M Bornstein et al have found that acute ischaemic stroke patients ineligible for thrombolytic therapy and with confirmed cortical involvement (CCI) may benefit from an injectable neurostimulator implant that acts on the sphenopalatine ganglion (SPG). The SPG stimulation showed to increase cerebral collateral blood flow, stabilised the blood–brain barrier, and reduced infarct size, in preclinical models of acute ischaemic stroke. The sphenopalatine ganglion stimulation showed functional outcome in a pilot randomised trial in humans when conducted 8–24 hour after the stroke onset. Between June 10, 2011, and March 7, 2018, 1078 patients were enrolled and randomly assigned to either the intervention or the sham-control group of the trial. 1000 patients received at least one session of sphenopalatine ganglion stimulation or sham stimulation. 520 (52%) patients had CCI on imaging. About 49% (234/481) in the intervention group showed better outcomes in their 3-month disability level compared to a 45% (236/519) in the sham-control group. In the CCI population, the proportion was 50% (121/244) in the intervention group versus 40% (110/276) in the sham-control group. Though the trial lacks significant evidence, the findings suggest SPG stimulation to be safe and likely to improve functional outcome among patients with cortical involvement.

Source : The Lancet May 24, 2019 DOI: https://doi.org/10.1016/S0140-6736(19)31192-4

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