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Effects of intraaortic balloon counterpulsation on carotid artery blood flow
R M Applebaum1, H H Wun, E S Katz
1Department of Medicine, New York University School of Medicine, NY, USA.
Insights
Intra-aortic balloon pump counterpulsation did not increase total carotid artery blood flow in patients. This was due to a systolic blood flow reversal that negated augmented diastolic flows, potentially limiting cerebral blood flow benefits.
Area of Science:
- Cardiovascular Physiology
- Medical Device Technology
Background:
- Intra-aortic balloon pumps (IABP) can enhance cardiac output and coronary flow.
- Previous animal studies showed inconsistent effects of IABP on cerebral blood flow.
- Human studies are needed to clarify IABP's impact on carotid artery blood flow.
Purpose of the Study:
- To investigate the effects of IABP counterpulsation on common carotid artery blood flow in humans.
- To determine if IABP improves cerebral perfusion in critically ill patients.
Main Methods:
- Carotid Duplex scanning was used to assess common carotid artery blood flow.
- 14 patients with IABP were studied, including hypotensive patients and those post-cardiac surgery or angioplasty.
- Blood flow was measured with and without 1:1 balloon augmentation.
Main Results:
- No net increase in total common carotid artery blood flow was observed with IABP.
- A significant increase in peak diastolic flow velocity and flow velocity integral occurred.
- An early systolic reversal of blood flow during augmentation negated the diastolic flow increase.
Conclusions:
- IABP counterpulsation did not increase total carotid artery blood flow.
- Improper balloon deflation timing may cause systolic flow reversal, negating diastolic augmentation.
- IABP may not improve cerebral blood flow in critically ill patients due to timing issues.
Background:
The intraaortic balloon pump has been shown to improve cardiac output and diastolic coronary flow. Animal studies with balloon counterpulsation have shown variable effects on carotid and cerebral blood flow. We investigated the effects of counterpulsation with the intraaortic balloon pump on blood flow in the common carotid artery in human beings.
Methods And Results:
We studied 14 patients who had an intraaortic balloon pump placed for clinical indications; 9 were hypotensive (4 in the setting of an acute myocardial infarction and 5 immediately after cardiac surgery). Five patients required counterpulsation after undergoing complicated coronary angioplasty. Common carotid artery blood flow was assessed with carotid Duplex scanning both with and without 1:1 balloon augmentation. We found no net increase in the total blood flow in the common carotid artery with intraaortic balloon counterpulsation. This result occurred despite a significant mean increase in both the peak flow velocity and flow velocity integral of the augmented diastolic flows by 160% and 78%, respectively. Total flow did not change because an early systolic reversal of blood flow was seen only with balloon augmentation, which negated the augmented diastolic flow.
Conclusion:
Despite a significant augmentation in diastolic blood flow with balloon counterpulsation, no increase occurred in total carotid artery blood flow. This appeared to be caused by improper timing of balloon deflation. This could result in no improvement in cerebral blood flow with intraaortic balloon pump counterpulsation in critically ill patients.
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