Vagus nerve stimulation paired with rehabilitation for stroke: Implantation experience from the VNS-REHAB trial

Charles Y. Liu, Jonathan Russin, David P. Adelson, Alistair Jenkins, Omar Hilmi, Benjamin Brown, Bradley Lega, Tony Whitworth, Dev Bhattacharyya, Theodore H. Schwartz, Vibhor Krishna, Ziv Williams, Christopher Uff, Jon Willie, Caitlin Hoffman, William A. Vandergrift, Achal Singh Achrol, Rushna Ali, Peter Konrad, Joseph EdmondsDaniel Kim, Pragnesh Bhatt, Brent W. Tarver, David Pierce, Ravi Jain, Chester Burress, Reema Casavant, Cecília N. Prudente, Navzer D. Engineer

Research output: Contribution to journalArticlepeer-review


Objective: Vagus Nerve Stimulation (VNS) paired with rehabilitation delivered by the Vivistim® Paired VNS™ System was approved by the FDA in 2021 to improve motor deficits in chronic ischemic stroke survivors with moderate to severe arm and hand impairment. Vagus nerve stimulators have previously been implanted in over 125,000 patients for treatment-resistant epilepsy and the surgical procedure is generally well-tolerated and safe. In this report, we describe the Vivistim implantation procedure, perioperative management, and complications for chronic stroke survivors enrolled in the pivotal trial. Methods: The pivotal, multisite, randomized, triple-blind, sham-controlled trial (VNS-REHAB) enrolled 108 participants. All participants were implanted with the VNS device in an outpatient procedure. Thrombolytic agents were temporarily discontinued during the perioperative period. Participants were discharged within 48 hrs and started rehabilitation therapy approximately 10 days after the Procedure. Results: The rate of surgery-related adverse events was lower than previously reported for VNS implantation for epilepsy and depression. One participant had vocal cord paresis that eventually resolved. There were no serious adverse events related to device stimulation. Over 90% of participants were taking antiplatelet drugs (APD) or anticoagulants and no adverse events or serious adverse events were reported as a result of withholding these medications during the perioperative period. Conclusions: This study is the largest, randomized, controlled trial in which a VNS device was implanted in chronic stroke survivors. Results support the use of the Vivistim System in chronic stroke survivors, with a safety profile similar to VNS implantations for epilepsy and depression.

Original languageEnglish (US)
Pages (from-to)122-128
Number of pages7
JournalJournal of Clinical Neuroscience
StatePublished - Nov 2022


  • Chronic stroke
  • Neuromodulation
  • Stroke rehabilitation
  • Vagus Nerve Stimulation
  • VNS implantation

ASJC Scopus subject areas

  • Surgery
  • Neurology
  • Clinical Neurology
  • Physiology (medical)


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