Intra-aortic balloon counterpulsation: augmentation of cerebral blood flow after aneurysmal subarachnoid haemorrhage.
OBJECTIVE
To measure cerebral blood flow before and after intra-aortic balloon counterpulsation (IABC) in patients at high risk of developing delayed cerebral ischaemia after aneurysm surgery following subarachnoid haemorrhage.


METHODS
Six prospectively selected patients at high risk of developing delayed ischaemia had elective IABC after clipping of their cerebral aneurysm(s). The IAB inflates in early diastole and deflates at the end of diastole to increase cardiac perfusion and decrease afterload. This results in enhanced cardiac efficiency. It also augments cerebral blood flow (CBF).


RESULTS
We demonstrated a significant increase in the mean hemispheric CBF from the preoperative (preIABC) value of 35.6 mls/100 g/min to 50.9 +/- 12.3 mls/100 g/min (p = 0.0042) as a result of balloon augmentation. Each patient developed a neurological deficit as a result of delayed cerebral ischaemia. These were reversed in 5 patients with increased CBF. There were minimal balloon related complications.


CONCLUSIONS
IABC consistently enhanced CBF in these patients and resulted in stable cardiovascular parameters. This represents a possible new technique in the management of cerebral ischaemia following subarachnoid haemorrhage and needs further assessment to ascertainlits role.
Spann
R G
RG
Wessex Neurological Center, Southampton University Hospitals, UK.
Lang
D A
DA
Birch
A A
AA
Lamb
R
R
Neil-Dwyer
G
G
D000328:Adult; D000368:Aged; D001921:Brain / Q000098:blood supply / Q000473:pathology; D002545:Brain Ischemia / Q000209:etiology* / Q000473:pathology / Q000517:prevention & control; D005260:Female; D006801:Humans; D007423:Intra-Aortic Balloon Pumping; D002532:Intracranial Aneurysm / Q000150:complications / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012039:Regional Blood Flow; D012307:Risk Factors; D013345:Subarachnoid Hemorrhage / Q000473:pathology / Q000601:surgery*