Stimulation of the Spenopalatine Ganglion Improves Outcomes in Patients With Acute Ischaemic Stroke: Presented at ISC

By Alex Morrisson

HONOLULU -- February 11, 2019 -- Stimulation of the sphenopalatine ganglion (SPG) with a device appears to improve functional outcomes among a subset of patients diagnosed with acute ischaemic stroke, according to a study presented here at the 2019 International Stroke Conference(ISC).

Stimulation of the SPG has been associated with increased cerebral collateral blood flow, stabilisation of the blood-brain barrier, and reduced infarct size.

In analysing pooled data from the ImpACT 24A and ImpACT 24B trials, 48.9% of the 634 patients who had SPG stimulation had outcomes considered better than expected on a sliding dichotomy assessment compared with 44.6% of the 619 patients who received sham stimulation (odds ratio = 1.19; 95% confidence interval, 0.95-1.48; P = .13) -- a non-significant finding.

However, when researchers scrutinised outcomes in patients who had a conformed cortical involvement stroke, there was a significant positive finding. Of the 294 people treated with stimulation, 34% achieved better than expected outcomes -- achieving a 0-2 score on the modified Rankin Scale -- compared with 26% of the 313 treated with sham (P = .005).

“SPG stimulation in these patients was safe,” said Ashfaq Shuaib, MD, University of Alberta, Edmonton, Alberta. “There was no difference in adverse events, and placement was fast and robust.”

“This meta-analysis further supports that in patients with acute ischaemic stroke with confirmed cortical infarcts, SPG stimulation started within 24 hours reduced post-stroke disability over the entire outcome range and increases the proportion of patients who are alive and independent 3 months after stroke,” he said.

Patients had an average National Institutes of Health Stroke Scale score of 12, more than 80% were diagnosed with hypertension, and about 25% were diagnosed with diabetes. The primary endpoint was improvement on the modified Rankin Scale at 90 days using a sliding dichotomy, assessed in the modified intention-to-treat populations and in those with confirmed cortical involvement. In the confirmed cortical involvement group, about 31% had atrial fibrillation while in the intention to treat population, about 25% had atrial fibrillation.

[Presentation title: Spenopalatine Ganglion Stimulation for the Treatment of Acute Ischemic Stroke: Pooled Meta-Analysis of the Impact 24A and Impact 24B Trials. Abstract LB12]

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