Use of intra-aortic balloon pump counterpulsation for refractory symptomatic vasospasm

Delayed neurologic deficits secondary to vasospasm remain a vexing problem. Current treatments include: hypertensive hypervolemic hemodilution (Triple -H) therapy, angioplasty, and intraarterial papaverine administration. Sign ificant morbidity and mortality still result from vasospasm despite these t herapies. We present two patients with symptomatic vasospasm who received i ntra-aortic balloon pump counterpulsation (IABP) to improve cerebral blood flow when they were unable to tolerate Triple-II therapy. One patient (L.T. ) developed vasospasm after resection of a meningioma that encased the caro tid and middle cerebral artery. The other patient (D.F.) suffered a subarac hnoid hemorrhage (Fisher Grade III, Hunt/Hess Grade III) from a basilar tip aneurysm. Postoperatively, both patients developed vasospasm. Treatment wi th Triple-II therapy, angioplasty, and papaverine yielded modest results. W hen they experienced cardiac ischemia, Triple-II therapy was stopped, but t heir neurologic condition deteriorated markedly. Because of this, IABP was started. Both patients had an immediate improvement in cardiac function. IA BP was able to reverse some of the neurologic deficits, and was weaned off after several days of support. Both patients had a substantial improvement in function, and are now capable of caring for themselves. We conclude that IABP may play an important role for improving cerebral blood how in patien ts with vasospasm. It may be particularly useful in those patients with lim ited cardiac reserve.