The Impact of Peripheral Nerve Stimulation on Coronary Blood Flow and Endothelial Function
The geko™ device is a small transcutaneous nerve stimulator that is applied non-invasively to the skin over the common peroneal nerve to stimulate peripheral blood flow. The purpose of this study was to investigate the effect of peripheral nerve stimulation on coronary flow dynamics and systemic endothelial function.
We enrolled 10 male patients, age 59 ± 11 years, with symptomatic obstructive coronary disease undergoing percutaneous coronary intervention (PCI). Coronary flow dynamics were assessed invasively using Doppler flow wire at baseline and with nerve stimulation for 4 min. Measurements were taken in the stenotic coronary artery and in a control vessel without obstructive disease. At a separate visit, peripheral blood flow at the popliteal artery (using duplex ultrasound assessment) and endothelial function assessed by peripheral artery tonometry (PAT) were measured at baseline and after one hour of nerve stimulation.
Compared to baseline, there was a significant increase in coronary blood flow as measured by average peak velocity (APV) in the control vessel with nerve stimulation (20.3 ± 7.7 to 23.5 ± 10 cm/s; p = 0.03) and non-significant increase in the stenotic vessel (21.9 ± 12 to 23.9 ± 12.9 cm/s; p = 0.23). Coronary flow reserve did not change significantly. Reactive hyperemia-peripheral arterial tonometry (Rh-PAT) increased from 2.28 ± 0.39 to 2.67 ± 0.6, p = 0.045.
A few minutes of peripheral nerve stimulation may improve coronary blood flow. This effect is more prominent in non-stenotic vessels. Longer stimulation improved endothelial function.
KeywordsAngina Endothelium Blood flow Coronary artery disease Electrical stimulation
Compliance with Ethical Standards
Conflict of Interest
The authors report no relationships that could be construed as a conflict of interest.
The study was supported by an unrestricted grant from Firstkind Ltd. (United Kingdom).
- 2.Masuda D, Nohara R, Hirai T, Kataoka K, Chen L, Hosokawa R, et al. Enhanced external counterpulsation improved myocardial perfusion and coronary flow reserve in patients with chronic stable angina. Evaluation by13N-ammonia positron emission tomography. Eur Heart J. 2001;22:1451–8.CrossRefPubMedGoogle Scholar
- 8.Jessurun GA, Tio RA, De Jongste MJ, Hautvast RW, Den Heijer P, Crijns HJ. Coronary blood flow dynamics during transcutaneous electrical nerve stimulation for stable angina pectoris associated with severe narrowing of one major coronary artery. Am J Cardiol. 1998;82:921–6.CrossRefPubMedGoogle Scholar
- 16.Lavi S, McConnell JP, Rihal CS, Prasad A, Mathew V, Lerman LO, et al. Local production of lipoprotein-associated phospholipase A2 and lysophosphatidylcholine in the coronary circulation association with early coronary atherosclerosis and endothelial dysfunction in humans. Circulation. 2007;115:2715–21.CrossRefPubMedGoogle Scholar
- 20.Jawad H The effectiveness of a novel neuromuscular electrostimulation method versus intermittent pneumatic compression in enhancing lower limb blood flow. J Vasc Surg. 2012;2:160–5.Google Scholar
- 27.Loh PH, Cleland JG, Louis AA, Kennard ED, Cook JF, Caplin JL, et al. Enhanced external counterpulsation in the treatment of chronic refractory angina: a long-term follow-up outcome from the international enhanced external counterpulsation patient registry. Clin Cardiol. 2008;31:159–64.CrossRefPubMedGoogle Scholar