First Exemplar of a Transcranial Electrical Stimulation in Stroke Early After Onset Clinical Trial Patient
hyperintensities, left occipital hypoperfusion, acute ischemic stroke, infarctions
ACUTE INFARCTS, HYPOPERFUSION
Patient 1 was a male in his 70s with acute ischemic stroke due to bilateral posterior cerebral artery (PCA) occlusions. Given the symptomatic nature of the left PCA occlusion, he received 20 minutes of 1 milliamp (mA) high-definition (HD) cathodal transcranial direct current stimulation to the left occipital region only. Early alleviation of hypoperfusion, enhancement of relative cerebral blood volume, and recanalization were only observed on the stimulated side (left occipital lobe–left PCA territory). The contralateral right side, an internal control, remained ischemic due to persistent occlusion, highly suggestive of a true biological effect of stimulation.A, Acute infarctions of bilateral occipital regions (diffusion-weighted image [DWI] hyperintensities); hypoperfusion of bilateral PCA territories (time-to-maximum [Tmax] >6 seconds); symmetric bilateral relative cerebral blood volume (rCBV); bilateral PCA occlusions on MRA. B, A selection of PCA HD montage with current models predicting the e-field concentration over the ischemic region. C and D, Evolving bilateral occipital lobes acute infarcts (DWI hyperintensities); early and sustained alleviation of left occipital hypoperfusion; early and sustained rCBV enhancement of left occipital region; early and sustained left PCA partial recanalization. MRA indicates magnetic resonance angiography; MRI, magnetic resonance imaging.