Clinical Evaluation of Enhanced External Counterpulsation in the Treatment of Acute Cerebral Infarction
Authors
Zhu Wenbing, Niu Jingzhong, Wang Jiansheng, Chen Kejing
Department of Neurology, Zhongshan Hospital, Affiliated with Shanghai Medical University
Source: usecp.com (Compiled and reviewed by Gong Guoji)
Abstract
Objective: To evaluate the clinical efficacy of Enhanced External Counterpulsation (ECP) in treating acute cerebral infarction and its impact on blood rheology, regional cerebral blood flow (rCBF), and carotid artery hemodynamics.
Methods: Seventy-one patients with acute cerebral infarction of the internal carotid artery system were divided into an ECP group (n=38, ECP combined with low-molecular-weight dextran) and a control group (n=33, low-molecular-weight dextran only). Neurological deficit scores, blood rheology indices, SPECT regional cerebral blood flow (rCBF), and common carotid artery hemodynamics were compared before and after treatment.
Results: The total effective rate (94.73%) and markedly effective rate (71.05%) in the ECP group were significantly higher than those in the control group (75.75% and 45.45%, respectively; P<0.05). Subgroup analysis indicated superior outcomes for patients treated within 7 days of onset and those with moderate-severity infarction. ECP significantly reduced whole blood viscosity, improved rCBF in the lesion area, and increased blood flow velocity and volume in the affected common carotid artery.
Conclusion: ECP is an effective therapy for acute cerebral infarction. it improves hemodynamics, promotes neurological recovery, and is particularly effective for moderate-severity cases and early-stage interventions.
Keywords: Ischemic stroke; Regional cerebral blood flow; Enhanced external counterpulsation; Blood rheology
Materials and Methods
I. Case Selection
Patients hospitalized at Zhongshan Hospital between March 1994 and April 1995 with cerebral infarction confirmed by CT or MRI.
Exclusion Criteria: Significant intracranial hypertension, coma, severe arrhythmia, heart failure, or hemorrhagic tendencies.
Classification: Mild (0–15 points), Moderate (16–30 points), Severe (31–45 points).
II. Treatment Protocol
ECP Group: Utilized a US-ECP sequential positive pressure counterpulsator once daily for 1 hour over a 12-day course (cuff pressure: 0.45 kg/cm2). Patients also received 500 mL of low-molecular-weight dextran intravenously daily.
Control Group: Received only the 500 mL low-molecular-weight dextran IV daily for 12 days.
Baseline Therapy: Both groups received oral Vitamin B1 and Piracetam.
III. Evaluation and Statistics
Clinical Indices: Final assessment at the end of week 4 (Cured, Markedly Improved, Improved, Unchanged, Deteriorated, Death). Calculation of Mean Decrease in Stroke Neurological Deficit (MDSND).
rCBF: Measured via SPECT imaging.
Carotid Flow: Measured using the CBACV-300 hemodynamic analyzer.
Statistics: Data presented as xˉ±s; analyzed via t-test, ANOVA, and χ2 test.
Results and Discussion
I. Clinical Efficacy
The total effective rate in the ECP group (94.73%) was significantly higher than the control group (75.75%, P<0.05).
Table 1. Clinical Therapeutic Effects Between Groups
| Group | n | Cured | Markedly Improved | Improved | Unchanged | Effective Rate (%) |
|---|---|---|---|---|---|---|
| ECP | 38 | 6 | 21 | 9 | 2 | 94.73 |
| Control | 33 | 1 | 14 | 10 | 8 | 75.75 |
Table 2. Influence of Treatment Timing on Efficacy (MDSND)
| Group | ≤7 Days Post-Onset (n) | MDSND (xˉ±s) | >7 Days Post-Onset (n) | MDSND (xˉ±s) |
|---|---|---|---|---|
| ECP | 14 | 7.36±4.82∗ | 24 | 5.25±4.32 |
| Control | 19 | 4.32±3.08 | 14 | 3.86±4.19 |
Note: ∗ indicates P<0.05 compared to the control group.
Table 3. Correlation Between Disease Severity and Efficacy
| Severity | Group | n | Pre-Tx Mean Score | Post-Tx Mean Score | MDSND | % Reduction |
|---|---|---|---|---|---|---|
| Mild | ECP | 25 | 5.76 | 2.40 | 3.36±2.02 | -58.33% |
| Control | 21 | 4.86 | 2.57 | 2.29±1.78 | -47.05% | |
| Moderate | ECP | 13 | 21.76 | 10.76 | 11.15±3.86∗ | -50.53% |
| Control | 12 | 23.66 | 16.33 | 7.33±3.72 | -30.98% |
Note: ∗ indicates P<0.05 compared to the moderate control subgroup.
II. Blood Rheology and rCBF
Post-treatment, the ECP group showed a significantly greater reduction in whole blood reduced viscosity and erythrocyte aggregation index (P≤0.01). SPECT analysis revealed that the increase in rCBF in the lesion area was significantly higher in the ECP group compared to the control group (P≤0.05).
III. Carotid Artery Hemodynamics
Post-ECP, mean blood flow velocity (Vmean) and flow volume (Qmean) in the affected common carotid artery increased by 27.73% and 19.91%, respectively. This improvement persisted for at least 6 days post-treatment.
Conclusion
Enhanced External Counterpulsation (ECP) is a safe and effective adjunct therapy for acute cerebral infarction. Its therapeutic superiority is most evident when initiated within 7 days of onset and in patients with moderate severity. The mechanism involves:
- Rheological improvement: Reducing blood viscosity and aggregation.
- Enhanced Perfusion: Significant increase in regional cerebral blood flow and carotid artery supply.
- Functional Recovery: Accelerating the improvement of neurological deficits through improved hemodynamics.