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Large Vessel OcclusionNUVISTA2NCT07404852

Non-invasive Vagus Nerve Stimulation to Reduce Inflammation and Brain Injury Blood Biomarkers Following an Acute Ischemic Stroke

A study testing transcutaneous auricular vagal nerve stimulation in people with Large Vessel Occlusion and Acute Ischemic Stroke, run by Washington University School of Medicine at 1 site in United States.

Recruiting

Looking for participants now. Contact the study team or a site below to ask about taking part.

Sites and contacts
Official record
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Trial summary

This is a randomized open-label, with blinded outcome pilot study to evaluate the effect on inflammatory and brain injury laboratory values and explore clinical outcomes in patients who present with ischemic strokes due to large vessel occlusions and are treated with either current accepted management, or accepted… Read more about this study

Who is it for?
Ages 18 to 99 years
Conditions the study is for
Large Vessel Occlusion, Acute Ischemic Stroke
What is being tested?
transcutaneous auricular vagal nerve stimulation
Type of treatment
Medical device
Could I receive a placebo?
Yes, some participants may receive a placebo
How many people
65 participants
Where
1 siteUnited States
Study dates
23 Feb 2026to 29 Feb 2028
Phase
Interventional
Are there results?
Not yet: the study is under way

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 to 99 years
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Adult patients who present with acute ischemic strokes due to large vessel occlusions

Who cannot join

  • <18 years old
  • patients with presumed chronic large vessel occlusions
  • NIHSS<6
  • pre-morbid modified Rankin score (mRS) >2
  • unable to initiate treatment under 24 hours from symptom discovery
  • Chronic or acute infection, Recent surgery, active immune disease
Show all 9Show fewer
  • life expectancy <3 months
  • patients' undergoing active cancer or immunosuppressive/modulating therapy
  • patients with sustained bradycardia on arrival with a heart rate <50 beats per minute.

Trial locations and contacts

1 site in 1 country. Contact the study team or a site near you to ask about taking part.

Angela Birke, MS contact

(314) 362-5291

birkea@wustl.edu

Osvaldo Laurido-Soto, MD contact

314-273-3294

ojlaurido-soto@wustl.edu

United States1 site, 1 recruiting
  • Barnes-Jewish Hospital

    St Louis, Missouri, 63110

    Angela Birke, MS, (314) 362-5291, birkea@wustl.edu

    Osvaldo J Laurido-Soto, MD, ojlaurido-soto@wustl.edu

    Recruiting

Other trials in United States

About this study

Official title: Neuromodulation Using Vagus Nerve Stimulation Following Ischemic Stroke as Therapeutic Adjunct 2

This is a randomized open-label, with blinded outcome pilot study to evaluate the effect on inflammatory and brain injury laboratory values and explore clinical outcomes in patients who present with ischemic strokes due to large vessel occlusions and are treated with either current accepted management, or accepted management in addition to transcutaneous auricular vagal nerve stimulation.

Read the detailed description

Ischemic stroke is a leading cause of death and long-term disability worldwide. Large vessel occlusion (LVO) accounts for ~38% of acute ischemic strokes (AIS) and is associated with disproportionately poor outcomes: without treatment, 64% of patients are dead or dependent at six months, and even after successful mechanical thrombectomy, nearly half have poor functional recovery. These data highlight a critical unmet need for adjunctive therapies that limit secondary brain injury following reperfusion.

Neuroinflammation is a major contributor to ischemic brain injury and neurologic deterioration after AIS. In experimental models, inhibition of inflammatory pathways reduces infarct size and improves outcomes, and in human AIS, elevations in pro-inflammatory cytokines are associated with worse recovery. However, clinical trials targeting individual inflammatory mediators have failed, suggesting that effective therapy may require coordinated modulation of multiple immune pathways rather than blockade of a single target. Vagus nerve stimulation (VNS) engages an evolutionary conserved neuroimmune reflex that broadly regulates innate and adaptive immune responses. While implantable VNS is not feasible in acute stroke, non-invasive transauricular VNS (taVNS) enables rapid deployment in emergent settings.

The investigators recently completed the Neuromodulation Using Vagus Nerve Stimulation Following Ischemic Stroke as Therapeutic Adjunct (NUVISTA) pilot randomized trial (n=35) in AIS patients with LVO. taVNS was rapidly deployable and safe, significantly attenuated the trajectory of plasma interleukin-6 (IL-6) and other inflammatory mediators, and demonstrated encouraging signals of improved clinical outcomes. These findings support further mechanistic and translational investigation in a well-powered cohort.

The central hypothesis of this proposal is that taVNS engages endogenous neuroimmune reflexes to reprogram peripheral immune responses following LVO AIS, resulting in reduced systemic inflammation, attenuation of neuroaxonal injury, and improved early recovery. The investigators will test this hypothesis in a randomized, sham-controlled clinical study of 65 AIS patients

Patients enrolled in the trial will be randomized to treatment with electrical stimulation to the auricular branch of the vagus nerve (intervention) or no stimulation to the auricular branch (Sham) via an auricular, transcutaneous vagus nerve stimulator. All patients will be fitted with the device, the investigators will attach the ear electrodes to the left ear. Stimulation sessions will occur for 20 minutes twice daily during the inpatient period. Patients will have electricity applied to the different nerves depending on the randomization, they will be treated with stimulation with the following parameters: frequency 20 Hz, pulse width 250 μm, and a fixed intensity of 0.5 milliampere. The amplitude of stimulation may be reduced if a patient complains of discomfort at the site of stimulation. The site of stimulation will be inspected daily before and after treatment to ensure there is no redness or irritation at the site. The investigators will obtain laboratory samples on admission, day 0, and every 1.5 days till day 7 or discharge (whichever occurs first) to assess the patients inflammatory markers.

Being tested
transcutaneous auricular vagal nerve stimulation, Sham transcutaneous vagal nerve stimulation
Keywords
Acute ischemic stroke, large vessel occlusion, cytokines, vagus nerve stimulator, brain injury biomarkers
Medical subject headings
Ischemic Stroke

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • transcutaneous auricular vagal nerve stimulationDevice

    Stimulus of the auricular branch of the vagal nerve with the transcutaneous auricular vagal nerve stimulation.

  • Sham transcutaneous vagal nerve stimulationDevice

    Patients assigned to the controls arm will have no electricity applied to the Auricular Branch of the Vagus Nerve.

Study groups in NCT07404852
Study groupRoleWhat they receive
Treatment - Stimulation with Transcutaneous Auricular Vagal Nerve StimulatorExperimentalAll patients will be fitted with the device, the investigator will attach an electrode to the left ear. Stimulation sessions will occur for 20 minutes twice daily during the inpatient period, the investigator will stimulate the auricular branch of the vagus nerve. Patients' will be treated with the following parameters: frequency 20 Hz, pulse width 250 μm, and and a fixed intensity of 0.5 milliampere.
Receives: Device: transcutaneous auricular vagal nerve stimulation
Control - No Stimulation Transcutaneous Auricular Vagal Nerve StimulatorSham comparatorAll patients will be fitted with the device, the investigator will attach an electrode to the left ear. Sham stimulation sessions will occur for 20 minutes twice daily during the inpatient period. Patients assigned to the controls arm will have no electricity applied to the auricular branch of the vagus nerve.
Receives: Device: Sham transcutaneous vagal nerve stimulation

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Brain Derived Tau

    The primary endpoints of the study will include changes in the levels of brain injury biomarkers measured at onset and every 1.5 days till day 7, or discharge (whichever occurs first), this includes: Brain Derived Tau (BD-tau). The investigators will measure BD-tau in aliquots from the plasma with mononuclear antibodies that recognizes a protein of 48 to 68 kilodalton specific to BD-tau. A functional assay will be measured in picogram/milliliter. Will utilize a high sensitivity assays to minimize floor effects.

    Measured: 7 days

  2. Neurofilament light chain

    The primary endpoints of the study will include changes in the levels of brain injury biomarkers measured at onset and every 1.5 days till day 7, or discharge (whichever occurs first), this includes: Neurofilament light chain (NfL). The investigators will measure NfL in aliquots from the plasma with mononuclear antibodies that recognizes a protein of 68-70 kilodalton specific to NfL. A functional assay will be measured in picogram/milliliter. Will utilize a high sensitivity assays to minimize floor effects.

    Measured: 7 days

  3. Interleukin - 1b - Changes and Differences in the Levels

    The primary endpoints of the study will include changes in the levels of inflammatory markers measured at onset and every 1.5 days till day 7, or discharge (whichever occurs first), this includes: Interleukin (IL) -1b. The investigators will measure IL-1b in aliquots from the plasma with mononuclear antibodies that recognizes a protein of 17-31 kilodalton specific to IL-1b. A functional assay will be measured in picogram/milliliter. Will utilize a high sensitivity assays to minimize floor effects.

    Measured: 7 days

  4. Interleukin - 6 - Changes and Differences in the Levels

    The primary endpoints of the study will include changes in the levels of inflammatory markers measured at onset and every 1.5 days till day 7, or discharge (whichever occurs first), this includes: Interleukin (IL) - 6. The investigators will measure IL-6 in aliquots from the plasma with mononuclear antibodies that recognizes a protein of 26 kilodalton specific to IL-6. A functional assay will be measured in picogram/milliliter. Will utilize a high sensitivity assays to minimize floor effects.

    Measured: 7 days

  5. Tumor Necrosis Factor Alpha - Changes and Differences in the Levels

    The primary endpoints of the study will include changes in the levels of inflammatory markers measured at onset and every 1.5 days till day 7, or discharge (whichever occurs first), this includes: Tumor necrosis factor alpha (TNF-a). The investigators will measure IL-1b in aliquots from the plasma with mononuclear antibodies that recognizes a protein of 17 kilodalton specific to TNF-a. A functional assay will be measured in picogram/milliliter. Will utilize a high sensitivity assays to minimize floor effects.

    Measured: 7 days

Secondary outcomes (2)
  1. Change in NIH Stroke Scale (NIHSS)

    This is a clinical secondary exploratory endpoints. The NIH Stroke Scale (NIHSS) is a clinical tool used to assess stroke severity, the score ranges from 0 up to 42 (higher is more severe). It will be assessed daily by the investigators and at time of discharge. The investigators will assess differences in NIHSS dependent of the intervention arm.

    Measured: 7 days

  2. Modified Ranking Scale (mRS)

    This is a clinical secondary exploratory endpoints. The Modified Ranking Scale (mRS) is a clinical tool used to assess functional status after suffering a stroke. It ranges from 0 up to 6. It will be assessed at day 90 over the phone. The investigators will assess differences in mRS dependent of the intervention arm.

    0 = no symptoms at all

    1. = No significant disability despite symptoms; able to carry out all usual duties and activities
    2. = Slight disability; unable to carry out all previous activities, but able to look after own affairs without assistance.
    3. = Moderate disability; requiring some help, but able to walk without assistance.
    4. = Moderately severe disability; unable to walk without assistance and unable to attend to own bodily needs without assistance
    5. = Severe disability; bedridden, incontinent and requiring constant nursing care and attention.
    6. = Dead

    Measured: 90 days

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted12 Feb 2026
  2. Study start23 Feb 2026
  3. Primary completion29 Nov 2027 (estimated)
  4. Study completion29 Feb 2028 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Model description
This is a randomized open-label, with blinded outcome pilot study to evaluate the effect on inflammatory and brain injury laboratory values and explore clinical outcomes in patients who present with ischemic strokes due to large vessel occlusions and are treated with either current accepted management, or accepted management in addition to transcutaneous auricular vagus nerve stimulation.
Masking
Triple blind
Who is masked
Participant, Care provider, Outcomes assessor
Enrolment
65 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT07404852
Sponsor's protocol ID
202601166
Acronym
NUVISTA2
Status last verified
Feb 2026
First submitted
4 Feb 2026
Last updated
13 Apr 2026
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
Yes
Individual data sharing
Yes: De-identified patient level data may be shared upon reasonable requested and approval by the institutions Human Research Protection Office

Publications

  • Laurido-Soto OJ, Tan G, Nielsen SS, Huguenard AL, Donovan KM, Xu I, Giles J, Dhar R, Adeoye O, Lee JM, Leuthardt E. Transcutaneous Auricular Vagus Nerve Stimulation Reduces Inflammatory Biomarkers after Large Vessel Occlusion Stroke: Results of a Prospective Randomized Open-Label Blinded Endpoint Trial. Transl Stroke Res. 2025 Dec 22;17(1):7. doi: 10.1007/s12975-025-01405-6.

    PubMed 41428140

Questions about this trial

What is this clinical trial studying?

A study testing transcutaneous auricular vagal nerve stimulation in people with Large Vessel Occlusion and Acute Ischemic Stroke, run by Washington University School of Medicine at 1 site in United States.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 1 inclusion and 9 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: looking for participants now, as of the sponsor's last update on 13 Apr 2026. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in United States. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. Some participants in this study may receive a placebo. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

This study is still under way. Results are not available in the source record yet.

How can a doctor refer a patient or contact the research team?

Contact Angela Birke, MS ((314) 362-5291, birkea@wustl.edu), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Brain Derived Tau (time frame: 7 days). The study lists 5 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT07404852, which also lists 1 linked publication.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 13 Apr 2026.

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