INTRAAORTIC BALLOON COUNTERPULSATION AUGMENTS CEREBRAL BLOOD-FLOW IN THE PATIENT WITH CEREBRAL VASOSPASM - A XENON-ENHANCED COMPUTED-TOMOGRAPHY STUDY

OBJECTIVE: We previously established the ability of infra-aortic ballo on counterpulsation (IABC) to improve cerebral blood flow (CBF) signif icantly in a canine model of cerebral vasospasm. This study was perfor med to assess the efficacy of IABC in a patient with cardiac dysfuncti on as-ed severe cerebral vasospasm that was refractory to traditional treatment measures. METHODS: We report our experience with the clinica l use of IABC to treat cerebral vasospasm in a patient who suffered su barachnoid hemorrhage and concomitant myocardial infarction. Hypertens ive, 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 p atient, and Xe-CT demonstrated significant improvement in CBF with IAB C. The average global CBF was 20.5 +/- 4.4 ml/100g/min before versus 3 4.7 +/- 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=0.6007). CBF improvement ranged Ra m 33% to 161% above baseline, average 69.3%. Mo 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 sugges t that IABC is a rational treatment option in select patients with ref ractory cerebral vasospasm who do not respond to traditional treatment measures.