The use of intra-aortic counterpulsation balloon for the treatment of cerebral vasospasm and edema.

The usual treatment of symptomatic cerebral vasospasm involves a triple combination of induced systemic hypertension, hypervolemia, and hemodilution (triple H) to raise brain perfusion pressure and to reduce the risk of an increase in brain infarct size. 1 Awad IA Carter LP Spetzler RF Medina M Williams Jr, FW Clinical vasospasm after subarachnoid hemorrhage: response to hypervolemic hemodilution and arterial hypertension. Stroke. 1987; 18: 365-372 Crossref PubMed Scopus (340) Google Scholar , 2 Mayberg MR Batjer HH Dacey R et al. Guideline for the management of aneurysmal subarachnoid hemorrhage: a statement for health care professionals from a special writing group of the Stroke Council, American Heart Association. Stroke. 1994; 25: 2315-2318 Crossref PubMed Scopus (437) Google Scholar Additional treatment can be envisaged in the form of intra-aortic counterpulsation balloons in patients who fail to respond to the usual procedure. Intra-aortic counterpulsation is a common procedure for the management of cardiac failure with the ability to decrease cardiac workload and to increase coronary perfusion. 3 Nanas JN Moulopoulos SD Counterpulsation: historical background, technical improvements, hemodynamic and metabolic effects. Cardiology. 1994; 84: 156-167 Crossref PubMed Scopus (106) Google Scholar In addition, some authors have shown, in animal models as well as in human subjects, 4 Nussbaum ES Heros RC Solien EE Madison MT Sebring LA Latchaw RE Intra-aortic balloon counterpulsation augments cerebral blood flow in a canine model of subarachnoid hemorrhage-induced cerebral vasospasm. Neurosurgery. 1995; 36: 878-886 Google Scholar , 5 Nussbaum ES Sebring LA Ganz WF Madison MT Intra-aortic balloon counterpulsation augments cerebral blood flow in the patient with cerebral vasospasm: a xenon-enhanced computer tomography study. Neurosurgery. 1998; 42: 206-214 Crossref PubMed Scopus (47) Google Scholar that the increase of cerebral perfusion brought about by intra-aortic counterpulsation could be beneficial in other clinical settings. We report the case of a patient who benefitted from intra-aortic counterpulsation during the treatment of a symptomatic cerebral vasospasm.