Refined Sphenopalatine Ganglion Stimulator Placement and Intensity Setting to Augment Blood Flow and Neurologic Function
| Autor: | Jeffrey L. Saver, Natia Zarqua, Yoram Solberg, Nino Kharaishvili, Maia Beridze, Tamar Janelidze, Natan M. Bornstein |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2019 |
| Předmět: |
Brain Infarction
Male Anterior Cerebral Artery Carotid Artery Common Original Contributions Clinical Sciences Stimulation Electric Stimulation Therapy law.invention ganglia Prosthesis Implantation Neurologic function Randomized controlled trial law Medicine Humans Pinch Strength collateral circulation Aged Ultrasonography Advanced and Specialized Nursing nasolacrimal duct Hand Strength business.industry Ganglia Parasympathetic Blood flow electrode Middle Aged Collateral circulation Ganglion Intensity (physics) Paresis medicine.anatomical_structure Implantable Neurostimulators Anesthesia Cerebrovascular Circulation ComputingMethodologies_DOCUMENTANDTEXTPROCESSING Arm biomarker Female Neurology (clinical) Augment Cardiology and Cardiovascular Medicine business |
| Zdroj: | Stroke |
| ISSN: | 1524-4628 0039-2499 |
| Popis: | Supplemental Digital Content is available in the text. Background and Purpose— Two large, randomized trials indicated that sphenopalatine ganglion (SPG) stimulation improves final disability outcome in acute anterior circulation patients with ischemic stroke with confirmed cortical involvement. This study evaluated 2 refinements in SPG stimulation treatment technique: (1) SPG electrode placement with real-time optical tracking guidance; and (2) stimulation intensity comfortable tolerance level selection using non-noxious facial physiological markers. Methods— This study was a single, active arm trial at 4 centers, enrolling patients with anterior circulation ischemic stroke, National Institutes of Health Stroke Scale 1 to 6 including arm weakness subitem score ≥1, not receiving recanalization therapies, and within 24 hours of onset. Stimulation level was set based on ipsilateral facial tingling sensation or lacrimation. SPG stimulation effects were assessed by measuring volumetric blood flow in the ipsilateral common carotid artery by ultrasound and grasp and pinch strength in the affected hand before and during stimulation, and by change in National Institutes of Health Stroke Scale from day 1 to 7. Results— Among 50 enrolled patients, age was median 66 years (interquartile range, 60–74), 44% were female, National Institutes of Health Stroke Scale median was 5 (interquartile range, 4–5), and median onset-to-screening time was 18 hours (interquartile range, 9–20). Median implantation skin-to-skin time was 4 minutes (interquartile range, 3–7), and all 50 implants were placed correctly. Comfortable tolerance level was found based on physiological biomarkers in 96% of patients, including 86% in the optimal, low-medium intensity range. SPG stimulation significantly increased common carotid artery peak systolic and end-diastolic blood flow (44%, P |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|