Acute Ischemic Stroke

Acute ischemic stroke, A novel potential approach to treating acute ischemic stroke by the electrical stimulation of an area at the back of the nose has show promising results in initial studies. The approach involves inserting a small electrode the size of a toothpick into the soft palate to stimulate the sphenopalatine ganglion, the source of parasympathetic innervation to the anterior cerebral circulation, with the aim of increasing collateral circulation and maintaining blood flow to vulnerable ischemic tissue in acute ischemic stroke.

The thrombolysis window

The intervention also appears effective when start up to 24 hours after stroke onset, thus potentially offering a treatment option for patients who have miss the thrombolysis window and may not be suitable for thrombectomy,” coauthor, Natan Bornstein, MD, Shaarei Zedek Medical Center, Jerusalem, Israel, add.

Saver explaine that good collateral blood flow is associate with slower infarct expansion; also improve prognosis and outcome in patients with acute ischemic stroke. Animal studies have shown that sphenopalatine ganglion stimulation up to 24 hours after the onset of stroke preserve the penumbra, reduce cerebral infarct volume, increase neuronal survival, and preserve the blood brain barrier leading to reduce cerebral edema and improve neurologic outcome.

For the study, 1000 patients with anterior circulation acute ischemic stroke; so not undergoing reperfusion therapy, were randomize to receive; so active sphenopalatine ganglion stimulation or sham stimulation starting 8 to 24 hours after stroke onset (median 19 hours). The stimulation was administer in daily 4-hour sessions, beginning immediately; so after the placement procedure and continuing for 5 consecutive days.

Dose response curve

They saw a very clear inverse U shape dose response curve; so with patients who receive low to medium doses of stimulation having better outcomes; hence whereas patients with high stimulation did only as well as control. They point out that the proportion of patients with a favorable outcome increase; so from 40% to 70% at low mid range intensity and decrease back to 40% at high intensity stimulation, Saver report.

Dose response relationships are regard as a special class of supporting evidence, Saver note. It is very hard for a dose–response relationship like this to arise from the play of chance; so this provides strong support that this is a genuine biological treatment effect. In addition, the dose response relationship see in this trial “match perfectly” with; so that see in the previous pilot study, and fits with what is see in animal models.

Gotz Thomalla, MD, University of Hamburg Medical Center, Germany; co-chair of the ESOC session; which the study was present said: “It is certainly an interesting new idea and they are always looking for new approaches just opening the vessels. However, the main study just miss significance and there are many further questions; so as to how to optimally use this stimulation, so further data are need.