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Guluma KZ, Liebeskind DS, Raman R, Rapp KS, Ernstrom KB, Alexandrov AV, Shahripour RB, Barlinn K, Starkman S, Grunberg ID, Hemmen TM, Meyer BC, Alexandrov AW. Feasibility and Safety of Using External Counterpulsation to Augment Cerebral Blood Flow in Acute Ischemic Stroke-The Counterpulsation to Upgrade Forward Flow in Stroke (CUFFS) Trial. J Stroke Cerebrovasc Dis 2015; 24:2596-604. [PMID: 26347398 DOI: 10.1016/j.jstrokecerebrovasdis.2015.07.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Revised: 06/28/2015] [Accepted: 07/16/2015] [Indexed: 10/23/2022] Open
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.
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Affiliation(s)
- Kama Z Guluma
- Department of Emergency Medicine, University of California, San Diego, California, USA.
| | - David S Liebeskind
- UCLA Stroke Center, Department of Neurology, University of California, Los Angeles, California, USA
| | - Rema Raman
- Family Medicine and Public Health and Neurosciences, University of California, San Diego, La Jolla, California, USA
| | - Karen S Rapp
- UCSD Stroke and Coordinating Center, University of California, San Diego, La Jolla, California, USA
| | - Karin B Ernstrom
- Family Medicine & Public Health, University of California, San Diego, La Jolla, California, USA
| | - Andrei V Alexandrov
- Department of Neurology, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Reza B Shahripour
- Neurosonology, Comprehensive Stroke Center, University of Alabama, Birmingham, Alabama, USA
| | - Kristian Barlinn
- Department of Neurology, Dresden University Stroke Center, Carl Gustav Carus University Hospital Dresden, Dresden, Germany
| | - Sidney Starkman
- UCLA Stroke Center and Departments of Emergency Medicine and Neurology, University of California, Los Angeles, California, USA
| | - Ileana D Grunberg
- UCLA Stroke Network, University of California, Los Angeles, California, USA
| | - Thomas M Hemmen
- Department of Neurosciences, UCSD Stroke Program, University of California, San Diego, La Jolla, California, USA
| | - Brett C Meyer
- Department of Neurosciences, UCSD Stroke Program, University of California, San Diego, La Jolla, California, USA
| | - Anne W Alexandrov
- College of Nursing, University of Tennessee Health Science Center, Memphis, Tennessee, USA
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Conway J. Home blood pressure recording. CLINICAL AND EXPERIMENTAL HYPERTENSION. PART A, THEORY AND PRACTICE 1986; 8:1247-94. [PMID: 3545554 DOI: 10.3109/10641968609044087] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Blood pressure is an inherently variable phenomenon. In addition to this the level rises in the clinical setting; a response which is extremely variable. Problems therefore arise in the diagnosis and treatment of hypertension. Studies have shown that blood pressure can reliably be measured at home either with a stationary or ambulatory apparatus. The readings which are reproducible are generally lower than those obtained in the clinic. Ambulatory recordings are a more reliable guide to prognosis and to the response to hypotensive agents. Home recordings should therefore be more widely used in diagnosis and treatment of the disorder.
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