title: The Impact of Peripheral Nerve Stimulation on Coronary Blood Flow and Endothelial Function.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: London Health Sciences Centre, 339 Windermere Road, PO Box 5339, London, ON N6A 5A5, Canada.|Western University, London, ON, Canada.|Princess Alexandra Hospital, University of Queensland, QLD, Australia.
authors.forename: Anthony C
authors.initials: AC
authors.lastname: Camuglia
authors.affiliation: London Health Sciences Centre, 339 Windermere Road, PO Box 5339, London, ON N6A 5A5, Canada.
authors.forename: Mistre
authors.initials: M
authors.lastname: Alemayehu
authors.affiliation: London Health Sciences Centre, 339 Windermere Road, PO Box 5339, London, ON N6A 5A5, Canada.
authors.forename: Andrew
authors.initials: A
authors.lastname: McLellan
authors.affiliation: London Health Sciences Centre, 339 Windermere Road, PO Box 5339, London, ON N6A 5A5, Canada.
authors.forename: Sabrina
authors.initials: S
authors.lastname: Wall
authors.affiliation: London Health Sciences Centre, 339 Windermere Road, PO Box 5339, London, ON N6A 5A5, Canada.
authors.forename: Nour
authors.initials: N
authors.lastname: Abu-Romeh
authors.affiliation: London Health Sciences Centre, 339 Windermere Road, PO Box 5339, London, ON N6A 5A5, Canada. shahar.lavi@lhsc.on.ca.|Western University, London, ON, Canada. shahar.lavi@lhsc.on.ca.
authors.forename: Shahar
authors.initials: S
authors.lastname: Lavi
keywords: Angina; Blood flow; Coronary artery disease; Electrical stimulation; Endothelium