The usual treatment of symptomatic cerebral vasospasm involves a triple combination
of induced systemic hypertension, hypervolemia, and hemodilution (triple H) to raise
brain perfusion pressure and to reduce the risk of an increase in brain infarct size.
1
,
2
Additional treatment can be envisaged in the form of intra-aortic counterpulsation
balloons in patients who fail to respond to the usual procedure. Intra-aortic counterpulsation
is a common procedure for the management of cardiac failure with the ability to decrease
cardiac workload and to increase coronary perfusion.
3
In addition, some authors have shown, in animal models as well as in human subjects,
4
,
5
that the increase of cerebral perfusion brought about by intra-aortic counterpulsation
could be beneficial in other clinical settings. We report the case of a patient who
benefitted from intra-aortic counterpulsation during the treatment of a symptomatic
cerebral vasospasm.To read this article in full you will need to make a payment
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References
- Clinical vasospasm after subarachnoid hemorrhage: response to hypervolemic hemodilution and arterial hypertension.Stroke. 1987; 18: 365-372
- Guideline for the management of aneurysmal subarachnoid hemorrhage: a statement for health care professionals from a special writing group of the Stroke Council, American Heart Association.Stroke. 1994; 25: 2315-2318
- Counterpulsation: historical background, technical improvements, hemodynamic and metabolic effects.Cardiology. 1994; 84: 156-167
- Intra-aortic balloon counterpulsation augments cerebral blood flow in a canine model of subarachnoid hemorrhage-induced cerebral vasospasm.Neurosurgery. 1995; 36: 878-886
- Intra-aortic balloon counterpulsation augments cerebral blood flow in the patient with cerebral vasospasm: a xenon-enhanced computer tomography study.Neurosurgery. 1998; 42: 206-214
- Prolonged experimental cerebral vasospasm.J Neurosurg. 1968; 29: 357-366
- Experimental augmentation of blood flow by intermittent aortic occlusion.J Neurosurg. 1972; 36: 700-713
- The intra-aortic balloon pump, a novel addition to staged repair of combined symptomatic cerebrovascular and coronary artery disease.Ann Vasc Surg. 1993; 7: 239-242
- Intra-aortic balloon pump counterpulsation in the management of concomitant cerebral vasospasm and cardiac failure after subarachnoid hemorrhage: technical case report.Neurosurgery. 1996; 38: 1056-1060
Article info
Publication history
Accepted:
July 3,
1999
Footnotes
*Surgery 1999;126:230-3.
**Reprint requests: Michel Montessuit, MD, Clinique de Chirurgie Cradio-vasculaire et Thoracique, Hôpital Cantonal des HUG, 24, rue Micheli-du-Crest, 1204 Genève, Switzerland.
Identification
Copyright
© 2000 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
