BackTable Vascular & Interventional Ep. 624 Integrating Spinal Cord Stimulation in Vascular Disease Management for CLTI with Dr. Mary Costantino and Jill Sommerset
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Mar 13, 2026 Jill Sommerset, vascular technologist and clinical education lead, and Dr. Mary Costantino, interventional radiologist specializing in complex peripheral artery disease, discuss spinal cord stimulation for no-option CLTI. They cover ultrasound mapping and pedal acceleration time, immediate perfusion changes during trial stimulation, practical barriers to permanent implants, comparisons to deep venous arterialization, and the need for larger studies.
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First No-Option CLTI Case Converted By Spinal Cord Stimulation
- Mary Costantino describes a first no-option CLTI patient who had severe distal calcified tibial disease, toe gangrene, and extreme pain that precluded normal life.
- During a trial spinal cord stim the team watched pedal acceleration time (PAT) improve live on duplex, the patient underwent bilateral forefoot amputations that healed and regained function.
Spinal Cord Stimulation Produces Rapid Measurable PAT Improvements
- Jill Sommerset and Mary observed immediate, setting-dependent improvements in pedal acceleration time (PAT) when spinal cord stimulation was turned on during trials.
- Seven of ten patients (seven limbs) with bilateral class 4 PAT improved to class 1 after stimulation, suggesting rapid distal perfusion changes in infrapopliteal disease.
Plan For Reimbursement And ASC Logistics Upfront
- Anticipate site-of-service and reimbursement barriers for permanent implants; trials are usually covered but permanent implantation often requires an ASC or willing implanting specialist.
- Build relationships with neurology/neurosurgery or secure ASC privileges to avoid long delays that harm wound patients.