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Transauricular Vagus Nerve Stimulation in Acute Ischaemic Stroke Requiring Mechanical Thrombectomy: Sham-Controlled,
Gareth L Ackland1, David Crane2, Sanjali Ahuja2
1Translational Medicine and Therapeutics, William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, EC1M 6BQ, UK. g.ackland@qmul.ac.uk.
Translational Stroke Research
|December 27, 2025
Summary
Transcutaneous auricular vagal nerve stimulation (tVNS) is safe for acute ischemic stroke patients undergoing mechanical thrombectomy. Early tVNS did not reduce blood pressure variability but showed potential immune system modulation.
Area of Science:
- Neurology
- Immunology
- Cardiovascular Science
Background:
- Autonomic dysfunction post-ischemic stroke causes hemodynamic instability and immunosuppression, worsening outcomes.
- Mechanical thrombectomy (MT) is a critical intervention for acute ischemic stroke.
- Non-invasive neuromodulation offers a potential therapeutic avenue for stroke complications.
Purpose of the Study:
- To investigate if transcutaneous auricular vagal nerve stimulation (tVNS) can reduce blood pressure variability and/or reverse immunosuppression in patients undergoing MT.
- To assess the safety and feasibility of tVNS in the hyperacute phase of ischemic stroke.
Main Methods:
- A phase 2, randomized, double-blind, sham-controlled trial (NCT05417009) involving 36 adult patients undergoing emergent MT.
- Patients received either active-tVNS or sham-tVNS throughout MT and the following morning.
- Primary outcome: systolic blood pressure variability (coefficient of variation) over 24h post-MT. Secondary outcomes: whole blood RNA sequencing and heart rate variability.
Main Results:
- Active-tVNS was safe and feasible in hyperacute stroke patients, with no serious adverse events.
- No significant difference in systolic blood pressure variability between active-tVNS (0.106±0.029) and sham-tVNS (0.107±0.027) groups (p=0.93).
- Active-tVNS modulated gene expression related to tumor necrosis factor and toll-like receptor signaling, alongside heart rate variability changes.
Conclusions:
- Early tVNS is safe and feasible for patients with acute ischemic stroke requiring MT.
- tVNS did not significantly alter systolic blood pressure variability in this cohort.
- tVNS demonstrated potential immunomodulatory effects and influenced heart rate variability, warranting further investigation.
