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

Neurosurgery. 1998 Jan;42(1):206-13; discussion 213-4. doi: 10.1097/00006123-199801000-00048.

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.

Publication types

  • Case Reports
  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

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

Substances

  • Xenon