Kama Z Guluma1, David S Liebeskind2, Rema Raman3, Karen S Rapp4, Karin B Ernstrom5, Andrei V Alexandrov6, Reza B Shahripour7, Kristian Barlinn8, Sidney Starkman9, Ileana D Grunberg10, Thomas M Hemmen11, Brett C Meyer11, Anne W Alexandrov12. 1. Department of Emergency Medicine, University of California, San Diego, California, USA. Electronic address: kguluma@ucsd.edu. 2. UCLA Stroke Center, Department of Neurology, University of California, Los Angeles, California, USA. 3. Family Medicine and Public Health and Neurosciences, University of California, San Diego, La Jolla, California, USA. 4. UCSD Stroke and Coordinating Center, University of California, San Diego, La Jolla, California, USA. 5. Family Medicine & Public Health, University of California, San Diego, La Jolla, California, USA. 6. Department of Neurology, University of Tennessee Health Science Center, Memphis, Tennessee, USA. 7. Neurosonology, Comprehensive Stroke Center, University of Alabama, Birmingham, Alabama, USA. 8. Department of Neurology, Dresden University Stroke Center, Carl Gustav Carus University Hospital Dresden, Dresden, Germany. 9. UCLA Stroke Center and Departments of Emergency Medicine and Neurology, University of California, Los Angeles, California, USA. 10. UCLA Stroke Network, University of California, Los Angeles, California, USA. 11. Department of Neurosciences, UCSD Stroke Program, University of California, San Diego, La Jolla, California, USA. 12. College of Nursing, University of Tennessee Health Science Center, Memphis, Tennessee, USA.
Abstract
BACKGROUND:External counterpulsation (ECP) increases perfusion to a variety of organs and may be helpful for acute stroke. METHODS: We conducted a single-blinded, prospective, randomized controlled feasibility and safety trial of ECP for acute middle cerebral artery (MCA) ischemic stroke. Twenty-three patients presenting within 48 hours of symptom onset were randomized into one of two groups. One group was treated with ECP for 1 hour at a pressure of up to 300 mmHg ("full pressure"). During the procedure, we also determined the highest possible pressure that would augment MCA mean flow velocity (MFV) by 15%. The other group was treated with ECP at 75 mmHg ("sham pressure"). Transcranial Doppler MCA flow velocities and National Institutes of Health Stroke Scale (NIHSS) scores of both groups were checked before, during, and after ECP. Outcomes were assessed at 30 days after randomization. RESULTS: Although the procedures were feasible to implement, there was a frequent inability to augment MFV by 15% despite maximal pressures in full-pressure patients. In sham-pressure patients, however, MFV frequently increased as shown by increases in peak systolic velocity and end diastolic velocity. In both groups, starting ECP was often associated with contemporaneous improvements in NIHSS stroke scores. There were no between-group differences in NIHSS, modified Rankin Scale Scores, and Barthel Indices, and no device or treatment-related serious adverse events, deaths, intracerebral hemorrhages, or episodes of acute neuro-worsening. CONCLUSIONS:ECP was safe and feasible to use in patients with acute ischemic stroke. It was associated with unexpected effects on flow velocity, and contemporaneous improvements in NIHSS score regardless of pressure used, with a possibility that even very low ECP pressures had an effect. Further study is warranted.
RCT Entities:
BACKGROUND: External counterpulsation (ECP) increases perfusion to a variety of organs and may be helpful for acute stroke. METHODS: We conducted a single-blinded, prospective, randomized controlled feasibility and safety trial of ECP for acute middle cerebral artery (MCA) ischemic stroke. Twenty-three patients presenting within 48 hours of symptom onset were randomized into one of two groups. One group was treated with ECP for 1 hour at a pressure of up to 300 mmHg ("full pressure"). During the procedure, we also determined the highest possible pressure that would augment MCA mean flow velocity (MFV) by 15%. The other group was treated with ECP at 75 mmHg ("sham pressure"). Transcranial Doppler MCA flow velocities and National Institutes of Health Stroke Scale (NIHSS) scores of both groups were checked before, during, and after ECP. Outcomes were assessed at 30 days after randomization. RESULTS: Although the procedures were feasible to implement, there was a frequent inability to augment MFV by 15% despite maximal pressures in full-pressure patients. In sham-pressure patients, however, MFV frequently increased as shown by increases in peak systolic velocity and end diastolic velocity. In both groups, starting ECP was often associated with contemporaneous improvements in NIHSS stroke scores. There were no between-group differences in NIHSS, modified Rankin Scale Scores, and Barthel Indices, and no device or treatment-related serious adverse events, deaths, intracerebral hemorrhages, or episodes of acute neuro-worsening. CONCLUSIONS:ECP was safe and feasible to use in patients with acute ischemic stroke. It was associated with unexpected effects on flow velocity, and contemporaneous improvements in NIHSS score regardless of pressure used, with a possibility that even very low ECP pressures had an effect. Further study is warranted.
Authors: J T Lindsay Wilson; Asha Hareendran; Marie Grant; Tracey Baird; Ursula G R Schulz; Keith W Muir; Ian Bone Journal: Stroke Date: 2002-09 Impact factor: 7.914
Authors: Wenhua Lin; Li Xiong; Jinghao Han; Howan Leung; Thomas Leung; Yannie Soo; Xiangyan Chen; Ka Sing Lawrence Wong Journal: J Clin Neurosci Date: 2013-12-08 Impact factor: 1.961
Authors: Wenhua Lin; Li Xiong; Jinghao Han; Thomas Wai Hong Leung; Yannie Oi Yan Soo; Xiangyan Chen; Ka Sing Lawrence Wong Journal: Stroke Date: 2012-09-20 Impact factor: 7.914