title: Bedside use of a dual aortic balloon occlusion for the treatment of cerebral vasospasm.
abstract: BACKGROUND
  Delayed ischemic neurological deficits (DIND) due to cerebral vasospasm remains a major cause of morbidity and mortality following aneurysmal subarachnoid hemorrhage (aSAH). Methods to prevent DIND remain limited both in safety and efficacy. A novel intra-aortic dual balloon catheter (NeuroFlo™: CoAxia, Maple Grove, MN) is under investigation for treatment of ischemic stroke, including DIND. Because this technique does not require cerebral artery navigation, it may be useful as a bedside procedure, outside of the conventional angiography suite. We report the first case of ultrasound-guided application of the NeuroFlo™ system at bedside in the Neurological Intensive Care Unit.
  
  
  METHODS
  A 52-year-old woman presented with Hunt Hess IV aSAH complicated by medically refractory cerebral vasospasm. Despite surgical clipping of her aneurysm, the patient remained critically ill, failing maximal conventional medical therapy. For that reason, the NeuroFlo™ system was deployed using two-dimensional, spectral and color-flow Doppler ultrasound guidance at the patient's bedside while maintaining all forms of cerebral blood flow monitoring.
  
  
  RESULTS
  The procedure was well tolerated and there was no complication.
  
  
  CONCLUSIONS
  Bedside application of the NeuroFlo™ system may be safely performed in critically ill patients. The NeuroFlo™ system is under investigation for treatment of refractory cerebral vasospasm to prevent delayed ischemic neurological disease.
authors.affiliation: Department of Interventional Neuroradiology and Neurosurgery, Columbia University Medical Center, New York, NY, USA. ga2294@columbia.edu
authors.forename: Geoffrey
authors.initials: G
authors.lastname: Appelboom
authors.forename: Dorothea
authors.initials: D
authors.lastname: Strozyk
authors.forename: Brian Y
authors.initials: BY
authors.lastname: Hwang
authors.forename: Joan
authors.initials: J
authors.lastname: Prowda
authors.forename: Neeraj
authors.initials: N
authors.lastname: Badjatia
authors.forename: Raimund
authors.initials: R
authors.lastname: Helbok
authors.forename: Philip M
authors.initials: PM
authors.lastname: Meyers
mesh_terms: D000800:Angioplasty, Balloon / Q000295:instrumentation* / Q000379:methods*; D002545:Brain Ischemia / Q000209:etiology / Q000628:therapy; D002560:Cerebrovascular Circulation; D003422:Critical Care / Q000379:methods; D005260:Female; D006801:Humans; D007423:Intra-Aortic Balloon Pumping; D008875:Middle Aged; D013345:Subarachnoid Hemorrhage / Q000150:complications*; D020301:Vasospasm, Intracranial / Q000209:etiology* / Q000628:therapy*