IMPROVED NEUROLOGICAL RECOVERY OF CEREBRAL INFARCTIONS AFTER PLASMAPHERETIC REDUCTION OF LIPIDS AND FIBRINOGEN

Background and Purpose: High fibrinogen levels have been assessed in c erebrovascular disease with a direct relation to both plasma and whole -blood viscosity, as well as cerebral blood flow. Heparin-induced extr acorporeal low density lipoprotein precipitation (HELP) is a new metho d that safely and effectively reduces fibrinogen and plasma lipoprotei ns and improves blood How properties. Methods: We studied 26 patients with acute embolic stroke and 22 with multi-infarct dementia. Each rec eived two treatments with HELP within 8 days. Each patient had measure ment of the important blood constituents and evaluation of changes in clinical signs and symptoms related to their cerebrovascular disease. Results: Each HELP treatment safely produced an immediate and signific ant reduction in rheological measures, including fibrinogen (P<.001), whole-blood viscosity at high and low shear rates, plasma viscosity, a nd red cell transit time (P<.01 each). Total cholesterol, low density lipoprotein (P<.0001 each), lipoprotein(a) (P<.003), and triglycerides (P<.0001) were also reduced. The treated group in both the acute stro ke group and the multi-infarct group showed improvement relative to th e untreated control subjects in Mathew scale, Mini-Mental State Examin ation, and activities of daily living test scores. These uniform impro vements persisted at least 3 days past the second HELP treatment. Conc lusions: These results support the hypothesis that the improved hemorh eologic property of blood is an important factor in clinical recovery as well as basic neurological function.