External Counterpulsation Effects on Clinical Outcomes, Transcranial Doppler, and Regional Cerebral Blood Flow in Acute Cerebral Infarction
Authors
Si-Jun Yang, De-Xiang Gu, Zhong-Zhu Cao, Fei Li, Jiu-Lin Shi
Department of Neurology, Shanghai Second Hospital of Textile Industry Bureau, Shanghai, China
Compiled, reviewed, and organized by Dr. Guoji Gong, usecp.com
Abstract
Objective: To observe the clinical efficacy, changes in Transcranial Doppler (TCD), and regional cerebral blood flow (rCBF) following external counterpulsation (ECP) treatment in patients with acute cerebral infarction.
Methods: Eighty patients with acute cerebral infarction confirmed by CT were randomized into an ECP treatment group (n=40, mean age 58±9 years) and a control group (n=40, treated with Compound Danshen Injection, mean age 55±8 years). The ECP group received counterpulsation at 0.4 kg/cm2, 60 minutes/day for 14 sessions. The control group received 16 mL Compound Danshen Injection in 250 mL normal saline, intravenously once daily for 14 days. TCD and rCBF (using 133Xe inhalation) were measured before and after the treatment course. Efficacy was rated based on national reporting standards.
Results: The total effective rate (cured + marked improvement + improvement) was 87.5% in the ECP group, significantly higher than 70% in the control group (X2=5.17, P<0.05). The mean rCBF post-treatment was significantly higher in the ECP group (55.60±6.1 mL/100g/min) compared to the control group (46.60±4.0 mL/100g/min). Improvement rates in TCD and rCBF in the ECP group were significantly higher than in the control group (P<0.01). Improvement in cerebral blood flow strongly correlated with clinical improvement.
Conclusion: ECP treatment significantly improves clinical outcomes, TCD parameters, and rCBF in patients with acute cerebral infarction, suggesting its efficacy in increasing cerebral perfusion.
Methods
Study Population
A total of 80 cases of acute cerebral infarction were enrolled between October 1993 and October 1995. All cases met the diagnostic criteria approved by the National Conference on Cerebrovascular Diseases and were confirmed by cranial CT.
Patients were randomly divided into two groups:
- ECP Treatment Group: 40 cases (25 males, 15 females), mean age 58±9 years.
- Control Group: 40 cases (21 males, 19 females), mean age 55±8 years.
Treatment Protocols
- ECP Treatment Group: Received External Counterpulsation (ECP) using a counterpulsation device. The counterpulsation pressure was set at 0.4 kg/cm2. Treatment was administered once daily for 60 minutes per session. One course consisted of 14 sessions.
- Control Group: Received 16 mL of Compound Danshen Injection in 250 mL of normal saline, intravenously once daily for 14 days.
Both groups were supplemented with auxiliary treatments (vascular reaction and Naoxinshu treatments). Efficacy was evaluated upon completion of the treatment course.
Assessment Methods
- Transcranial Doppler (TCD): Measured using a 3D Doppler cerebrovascular ultrasound detector (EME, Denmark).
- Regional Cerebral Blood Flow (rCBF): Measured using the CCEM200 brain image system with the 133Xe isotope inhalation method. The normal value for gray matter blood flow was 64.74±5.49 mL/100g/min.
Efficacy Evaluation
Efficacy was assessed according to national reporting standards: Cured, Marked Improvement, Improvement, or Ineffective.
Results
Clinical Efficacy
The total effective rate in the ECP treatment group (87.5%) was significantly higher than in the control group (70%).
X2=5.17, P<0.05
Table 1. Comparison of Clinical Efficacy Between the Two Groups
| Group | N | Cured | Marked Improvement | Improvement | Total Effective Rate |
|---|---|---|---|---|---|
| Treatment (ECP) | 40 | 13 (32.5%) | 14 (35%) | 8 (20%) | 87.5% |
| Control (Danshen) | 40 | 6 (15%) | 9 (22.5%) | 13 (32.5%) | 70% |
Regional Cerebral Blood Flow (rCBF)
The mean rCBF post-treatment was significantly higher in the ECP group (55.60±6.1 mL/100g/min) compared to the control group (46.60±4.0 mL/100g/min).
Pre-treatment rCBF: ECP group 45.70±6.0 mL/100g/min; Control group 44.70±5.0 mL/100g/min. There was a significant difference in rCBF before and after treatment in the ECP group (P<0.01).
Improvement in TCD and rCBF
Improvement rates in TCD and rCBF in the ECP group were significantly higher than in the control group, and improvement in cerebral blood flow correlated strongly with clinical improvement.
Table 2. Improvement in TCD and rCBF After Treatment in the Two Groups
| Group | Test Item | Pre-treatment Abnormal N | Improved N (%) | Unimproved N (%) |
|---|---|---|---|---|
| Treatment (ECP) | TCD | 34 | 23 (67.7%)†† | 11 (32.3%) |
| rCBF | 36 | 22 (61.1%)†† | 14 (38.9%) | |
| Control (Danshen) | TCD | 36 | 15 (41.7%)†† | 21 (58.3%) |
| rCBF | 35 | 14 (40%)†† | 21 (60%) |
Note: †† P<0.01 when comparing the Treatment group with the Control group.
Discussion
External Counterpulsation (ECP) is used as an auxiliary circulatory treatment for ischemic cerebrovascular diseases, primarily by elevating aortic and cerebral arterial pressure to increase cerebral blood flow (CBF) and improve cerebral ischemia. This randomized controlled study confirms that ECP can significantly increase CBF and produce pronounced therapeutic effects, leading to a marked amelioration of neurological deficits.
The mechanism by which ECP enhances CBF is likely due to:
- Increased Perfusion Pressure: By elevating aortic and cerebral artery pressure during diastole, ECP improves perfusion, particularly in patients whose cerebral autoregulation is compromised by arteriosclerosis.
- Collateral Recruitment: ECP facilitates reperfusion of the ischemic penumbra surrounding the lesion, which is critical for functional recovery.
The results from TCD and rCBF measurements validate that ECP improves cerebral hemodynamics. ECP treatment for acute cerebral infarction demonstrates a definite therapeutic effect and warrants further research.