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Reversed intracranial blood flow in patients with an intra-aortic balloon pump
1Department of Neurology, Yale University School of Medicine, New Haven, CT 06510.
Insights
Mechanical cardiac assist devices can alter cerebral blood flow. Transcranial Doppler ultrasonography revealed potential diastolic flow reversal in cerebral arteries during intra-aortic balloon pump use.
Area of Science:
- Neurology
- Cardiology
- Medical Imaging
Background:
- Mechanical cardiac assist devices are used to support patients with severe heart failure.
- Understanding their impact on cerebral hemodynamics is crucial for patient safety.
- Intra-aortic balloon pumps (IABP) are one such device requiring investigation.
Observation:
- Transcranial Doppler ultrasonography (TCD) was employed to monitor cerebral arterial blood flow in three patients on an IABP.
- Baseline measurements without the IABP showed normal cerebral blood flow velocities and waveforms.
- IABP function significantly altered diastolic blood flow dynamics.
Findings:
- During IABP inflation, diastolic blood velocity in cerebral arteries increased.
- IABP deflation led to a sharp decrease in diastolic velocity, with flow reversal observed in major cerebral arteries in two patients.
- The observed changes highlight significant hemodynamic effects on the cerebral circulation.
Implications:
- Transcranial Doppler ultrasonography is a valuable, non-invasive tool for assessing the cerebral hemodynamic effects of IABPs.
- Further research is needed to determine the clinical significance of diastolic flow cessation and reversal.
- Optimizing IABP timing sequences may enhance forward cerebral blood flow and improve patient outcomes.
Abstract:
As a preliminary investigation into the cerebral effects of mechanical cardiac assist devices, using transcranial Doppler ultrasonography I examined the basal cerebral arteries in three patients placed on an intra-aortic balloon pump. Unassisted systoles had normal blood velocities and waveforms. When the pump was in use, diastolic blood velocity during balloon inflation increased. As the balloon was deflated and intra-aortic pressure was dramatically lowered, diastolic blood velocity within the intracranial vessels decreased sharply. In two patients there was a reversal of blood flow in the middle cerebral, anterior cerebral, basilar, and vertebral arteries during late diastole. Although the clinical effects of cessation and reversal of blood flow in the cerebral circulation while on an intra-aortic balloon pump remain to be determined, transcranial Doppler ultrasonography appears to be a useful tool for measuring these hemodynamic effects. It may also be helpful in quantifying the effects of such pumps on cerebral blood flow and devising inflation/deflation timing sequences that maximize forward blood flow.
