Implementation and results of paired vagus nerve stimulation (Vivistim) program for neurorestoration following ischemic stroke: A single-center experience

Background: Vivistim, otherwise known as vagus nerve stimulation (VNS) paired with rehabilitation (paired VNS) for chronic upper extremity (UE) deficits post stroke, has been increasingly utilized. We present our 2-year institutional implementation of paired VNS. Methods: Patients who underwent paired VNS at our institution within the first 2 years of implementation were included. Following implantation, patients underwent ≥6 weeks of paired VNS. Fugl–Meyer assessment for UE (FMA-UE) and Wolf-Motor Function Tests (WMFT), both of which assess UE motor function, were obtained preoperatively and post paired VNS. Results: Twenty of 21 patients were implanted without complication. The mean age was 63 years, and 81% were male. Mean improvement in FMA-UE was 10 ( n = 16) points and 0.7 ( n = 2) points on WMFT, demonstrating a clinically meaningful response defined by a 6- or 0.4-point improvement on FMA-UE and WMFT, respectively. All patients reported satisfaction with paired VNS. One patient suffered a surgical site infection resulting in explant. There were no other adverse events. Our institution received full reimbursement from all insurers, both commercial and public. Conclusion: Despite distinct methodologies, retrospective analysis of our institution’s paired VNS experience demonstrates a promising 2–3× improvement in functional outcomes similar to VNS-REHAB. Critical factors potentially contributing to our success include initiation of a monthly multidisciplinary conference, outreach to local occupational therapy, physiatry practices, and stroke awareness groups. Our institution’s results provide external validation and demonstrate the generalizability of paired VNS for the robust VNS-REHAB trial. Paired VNS implementation proved clinically impressive and economically profitable for our institution, suggesting adoption is sensible.