Intra-aortic balloon counterpulsation augments cerebral blood flow in the patient with cerebral vasospasm: a xenon-enhanced computed tomography study.

Abstract

OBJECTIVE:

We previously established the ability of intra-aortic balloon counterpulsation (IABC) to improve cerebral blood flow (CBF) significantly in a canine model of cerebral vasospasm. This study was performed to assess the efficacy of IABC in a patient with cardiac dysfunction and severe cerebral vasospasm that was refractory to traditional treatment measures.

METHODS:

We report our experience with the clinical use of IABC to treat cerebral vasospasm in a patient who suffered subarachnoid hemorrhage and concomitant myocardial infarction. Hypertensive, hypervolemic, hemodilution therapy was ineffective, and IABC was instituted. Xenon-enhanced computed tomography (Xe-CT) was utilized to obtain serial measurements of CBF with and without IABC over a 4-day period.

RESULTS:

IABC dramatically improved cardiac function in this patient, and Xe-CT demonstrated significant improvement in CBF with IABC. The average global CBF was 20.5 +/- 4.4 ml/100g/min before versus 34.7 +/- 3.8 ml/100g/min after IABC (p < 0.0001, paired student's t-test). The lower the CBF before IABC, the greater the improvement with IABC (correlation coefficient r = 0.83, p = 0.0007). CBF improvement ranged from 33% to 161% above baseline, average 69.3%. No complications of IABC were observed.

CONCLUSIONS:

This is the first report demonstrating the ability of IABC to improve CBF in a patient with vasospasm. We suggest that IABC is a rational treatment option in select patients with refractory cerebral vasospasm who do not respond to traditional treatment measures.

• Authors: E S Nussbaum, L A Sebring, W F Ganz, M T Madison
• Journal: Neurosurgery (Neurosurgery) Vol. 42 Issue 1 Pg. 206-13; discussion 213-4 (Jan 1998) ISSN: 0148-396X [Print] United States
• PMID: 9442527 (Publication Type: Case Reports, Journal Article, Research Support, Non-U.S. Gov't, Review)

Chemical References

• Xenon

Topics

• Cerebrovascular Circulation (physiology)
• Evaluation Studies as Topic
• Female
• Humans
• Intra-Aortic Balloon Pumping (adverse effects)
• Ischemic Attack, Transient (diagnostic imaging, physiopathology, therapy)
• Middle Aged
• Myocardial Infarction (complications)
• Subarachnoid Hemorrhage (complications)
• Tomography, X-Ray Computed
• Xenon