Experimental augmentation of cerebral blood flow by intermittent aortic occlusion

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✓ Intermittent occlusion of the descending aorta just below the origin of the brachiocephalic vessels by a preformed balloon passed via the femoral artery is capable of significantly increasing the pressure and flow in the common carotid artery. Regional cerebral blood flow determination by the krypton-85 washout technique measured maximum increases of over 40% of the controls, which could easily be achieved and maintained. This technique apparently takes advantage of the finite delay in autoregulatory response to the increased arterial pressure before the onset of maximal autoregulation. Dogs were “pumped” in this way for up to 18 hours and survived in good health. Principal problems with this technique were the development of cerebral edema in the presence of diffuse established cerebral anoxia, and a shock-like cardiovascular response if the intermittent aortic occlusion was discontinued too abruptly. The clinical application of this technique to cerebral ischemia secondary to postoperative vasospasm may not require the extremes of hyperperfusion used in these experiments.

Article Information

Address reprint requests to: Frederick A. Simeone, M.D., Pennsylvania Hospital, Eighth and Spruce Streets, Philadelphia, Pennsylvania 19107.

© AANS, except where prohibited by US copyright law.

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Figures

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    Diagrammatic representation of physiological monitoring during intermittent aortic occlusion experiments.

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    Inflation and deflation of the intra-aortic balloon triggered by the R-wave of the electrocardiogram. The dark vertical line indicates the onset of intermittent aortic occlusion, and the time of inflation and deflation is recorded by the balloon marker.

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    The upward deflection of the balloon marker indicates the duration of a prolonged (10 sec) inflation of the intra-aortic balloon. A gradual decrement in intracranial pressure and carotid blood flow occurs half way during this inflation, presumably due to cerebrovascular autoregulation.

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    Recording from the right carotid blood flowmeter magnified to show the progressive increment in carotid flow to a maximum point during balloon inflation. Central venous pressure does not significantly change with aortic occlusion.

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    Intermittent aortic occlusion carried on at the optimum ratio of 8 seconds inflation to 2 seconds deflation. Intermittent aortic occlusion begins at the dark vertical line. Note that the right carotid artery blood flow is kept consistently above control levels.

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    Comparison of electromagnetic flow recordings from the renal and femoral arteries during one cycle of inflation and deflation. The line marked “control” indicates a linear relationship at rest. During inflation the femoral flow drops abruptly but real flow is maintained until near occlusion. During deflation renal flow recovers more slowly than femoral flow, but both overshoot control levels.

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    Effects of varying the duration of pumping on the regional cerebral blood flow in four valid intermittent aortic occlusion experiments tabulated graphically. The wavy vertical line indicates the beginning of the intermittent aortic occlusion, and the vertical arrows the termination. Despite the variability, it is clear that as intermittent aortic occlusion increases in duration the mean cerebral blood flow proportionately increases. In no animal did the mean cerebral blood flow exceed the highest recordings on this chart.

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