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Best Scientific Abstract Award Winner: Auricular Vagus Nerve Stimulation Mitigates Inflammation and Vasospasm Following Subarachnoid Hemorrhage: A Randomized Controlled Trial
Description
Background and Purpose: Inflammation contributes to morbidity following subarachnoid hemorrhage (SAH). Transauricular vagus nerve stimulation (taVNS) offers a noninvasive approach to target this deleterious inflammatory response following SAH.

Methods: In this prospective, triple-blinded, randomized, controlled trial, twenty-seven patients were randomized to taVNS or sham stimulation. Blood and cerebrospinal fluid (CSF) were collected to quantify inflammatory markers at baseline, and every three days during admission. Cerebral vasospasm severity via assessment of angiographic studies and functional outcomes (modified Rankin Scale, mRS) were analyzed.

Results: No adverse events occurred. Radiographic vasospasm was significantly reduced (p = 0.015), with serial vessel caliber measurements demonstrating a more rapid return to normal than sham (p < 0.001). In the taVNS group, TNF-α was significantly reduced in both plasma (days 7 and 10) and CSF (day 13); IL-6 was also significantly reduced in plasma (day 4) and CSF (day 13) (p < 0.05). Patients receiving taVNS had higher rates of favorable outcomes with an mRS < 2 at discharge (38.4% vs 21.4%) and first follow-up (76.9% vs 57.1%), with significant improvement from admission to first follow-up (p = 0.014), unlike the sham group (p = 0.18). The taVNS group had a significantly lower rate of discharge to skilled nursing facility or hospice (p = 0.04).

Conclusion: taVNS is a novel technique to treat SAH via a non-invasive method of neuro- and systemic immunomodulation. This trial supports that taVNS following SAH can mitigate the inflammatory response, reduce radiographic vasospasm, and potentially improve functional and neurological outcomes. This novel approach represents a paradigm shift in the treatment of SAH, addressing the global injurious inflammatory response.

Event Type
Abstract
TimeThursday, October 17th8:00am - 8:20am PDT
LocationHarbor Ballrooms B-C
Tracks
Science of Neurocritical Care
Focus Areas
Subarachnoid Hemorrhage
Target Audiences
Intermediate