Preliminary Findings of External Counterpulsation for Ischemic Stroke Patient With Large Artery Occlusive Disease (Click for Full study)
Jing Hao Han, MD; Thomas W. Leung, MD; Wynnie W. Lam, MD; Yannie O. Soo, MD; Anne W. Alexandrov, PhD; Vincent Mok, MD; Yee-Fong V. Leung, PhD; Raymond Lo, MD; Ka Sing Wong, MD
BACKGROUND and PURPOSE: We aimed to investigate the feasibility and therapeutic effect of external counterpulsation (ECP) in ischemic stroke.
METHODS: The trial was a randomized, crossover, assessment-blinded, proof-of-concept trial. ECP treatment consisted of 35 daily 1-hour sessions. Patients were randomized to either early (ECP weeks 1 to 7 and no ECP weeks 8 to 14) or late group (no ECP weeks 1 to 7 and ECP weeks 8 to 14). Primary outcomes were an overall change in National Institutes of Health Stroke Scale (NIHSS) and cerebral blood flow estimated by color velocity imaging quantification. Secondary outcomes were change in NIHSS, color velocity imaging quantification, favorable functional outcome (modified Rankin scale, 0 to 2), and stroke recurrence at weeks 7 and 14, respectively.
RESULTS: Fifty patients were recruited. At week 7, there was a significant change in NIHSS (early 3.5 vs late 1.9; P=0.042). After adjusting for treatment sequence, ECP was associated with a favorable trend of change in NIHSS of 2.1 vs 1.3 for non-ECP (P=0.061). Changes of color velocity imaging quantification were not significant but tended to increase with ECP. At week 14, a favorable functional outcome was found in 100% of early group patients compared to 76% in the late group (P=0.022).
Conclusion — ECP is feasible for ischemic stroke patients with larger artery disease.
Stroke.2008; 39: 1340-1343 Published online before print February 28, 2008, doi: 10.1161/STROKEAHA.107.500132
Cerebrovasc Dis. 2008;26(2):97-105. Epub 2008 Jun 17.
Is counterpulsation a potential therapy for ischemic stroke?
Source Department of Medicine and Therapeutics, Chinese University of Hong Kong, Hong Kong, China.
BACKGROUND:Despite the rapid progress in stroke prevention, effective acute stroke treatment except for thrombolysis is still lacking. Hypoperfusion is related to unfavorable functional outcome, further strokes and long-term mortality. Therefore, the need for a safe and effective way of increasing the cerebral blood flow seems obvious. Currently, there is a growing body of evidence to suggest that external counterpulsation (ECP) may enhance the blood supply to the brain and thus may be beneficial to patients with ischemic stroke.
METHODS:A MEDLINE search in combination with a search for papers in Chinese literature in the Wan Fang and China Academic Journal databases was carried out.
RESULTS:Preliminary investigations suggested that ECP may improve the clinical outcome of stroke patients. However, well-designed clinical studies exploring the therapeutic effects of ECP in ischemic stroke are very limited.
CONCLUSIONS:Randomized-controlled trials with a large sample size are needed to further define the efficacy and safety of ECP in acute stroke management. Future studies should provide insight into the value of ECP in ischemic stroke as well as its possible mechanisms.
(c) 2008 S. Karger AG, Basel.
PMID:18560211 [PubMed – indexed for MEDLINE
Cochrane Database Syst Rev. 2012 Jan 18;1:CD009264.
External counterpulsation for acute ischaemic stroke.
Lin S, Liu M, Wu B, Hao Z, Yang J, Tao W.
SourceDepartment of Neurology, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, Sichuan, China, 610041.
BACKGROUND: External counterpulsation (ECP) may improve cerebral blood flow, and it has been proposed as a potential therapy for patients with ischaemic stroke.
OBJECTIVES: To assess the efficacy and safety of ECP for acute ischaemic stroke.
SEARCH METHODS: We searched the Cochrane Stroke Group Trials Register (June 2011), Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, 2011 Issue 2), MEDLINE (1948 to June 2011), EMBASE (1980 to June 2011), CINAHL (1982 to June 2011), AMED (Allied and Complementary Medicine) (1985 to June 2011), China Biological Medicine Database (CBM) (1978 to June 2011), Chinese National Knowledge Infrastructure (CNKI) (1979 to June 2011), Chinese Science and Technique Journals Database (VIP) (1989 to June 2011) and Wanfang Data (1984 to June 2011). We also searched ongoing trials registers, reference lists and relevant conference proceedings and contacted authors and manufacturers of external counterpulsation devices.
Randomised controlled trials (RCTs) in which ECP (started within seven days of stroke onset) was compared with sham treatment or no treatment, or ECP plus routine treatment was compared with routine treatment alone, in patients with acute ischaemic stroke.
DATA COLLECTION AND ANALYSIS: Two review authors independently assessed trial quality and extracted data, checked for adverse events data and contacted trialists for missing information.
MAIN RESULTS: We included two trials involving 160 patients. Numbers of death or dependent patients at the end of at least three months follow-up were not reported in either of the included trials. The outcome measure used in the included trials was only the number of participants with improvement of neurological impairment after treatment according to the Modified Edinburgh-Scandinavian Stroke Scale (MESSS) or self-making criteria. ECP was associated with a significant increase in the number of participants whose neurological impairment improved (risk ratio (RR) 1.75, 95% confidence interval (CI) 1.37 to 2.23). Only one trial reported no adverse events.
AUTHORS’ CONCLUSIONS:The methodological quality of the included studies was poor, and reliable conclusions could not be drawn from the present data. High-quality and large-scale RCTs are needed.
PMID: 22259001 [PubMed – in process]
《Advances in Cardiovascular Diseases》2009-05
Enhanced External Counterpulsation:A Novel Rehabilitation Modality of Ischemic Cerebral Vascular Disease
LIANG Qi(Department of Rehabilitation Medicine,Sun Yat-sen University,Guangzhou 510080,China)
Ischemic cerebral vascular disease is a major cause of death and disability despite the rapid progress in management.Enhanced external counterpulsation(EECP) has shown to increase cerebral perfusion,therefore protect neurons from damage in the ischemic region.Preliminary investigations in China and other countries suggested that EECP might be an effective and safe intervention with few side-effects,but favorable clinical outcome in patients with stroke,although well-designed clinical trials are lacking.The mechanisms of action of EECP are still poorly understood and might be contributed to increasing brain perfusion,establishing collateral circulation,promoting endothelial function,angiogenesis and brain remodeling.Future studies are needed to delineate the therapeutic value of EECP for the treatment of ischemic cerebral vascular disease and subsequently its possible mechanisms.
Nuclear Techniques 1996-11
Assessment of the efficacy of external counter pulsation treatment in ischemic cerebral vascular diseases by brain SPECT imaging
Yao Weixuan; Chang Guojun; Xu Zhaoqiang ;Ma Yuqi;Lin Ji; Bao Lihua ;Li Yongjun; Xu Feng(The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029)
Twenty-two cases of ischemic cerebral vascular disease, diagnosed by clinical and experimental methods, were examined with 99mTc-ECD SPECT regional cerebral blood flow (rCBF) tomography adaging before and after treatment with exterenal counter pulsation (ECP). Before the treatment, there were 54 segments deficient in rCBF, while after the treatment 20 segments fully improved (37.5%), 19 segments podly approved (35.2%) and 15 segments not changed (27.8%).Therefore, totalefficacy reached up to 72.2%(39/54). The result suggested that SPECT is useful notonly for early diagnosis but also for the evaluation of the curative effect on ischemic cerebral vascular disease.
《Shanghai Medical Journal》1981-11
AN EXPERIMENTAL AND CLINICAL STUDY OF EXTERNAL COUNTERPULSATION ON CERTAIN DISEASES OF CEREBRAL VASCULAR INSUFFICIENCY:A PRELIMINARY REPORT
Cai Dawei et al.Shanghai First People’s Hospital
An experimental study on 11 dogs revealed that external counterpulsation(ECP)increased the blood flow of common carotid artery by over 75%,and the cerebral angio-graphy showed marked increase of blood flow in its collateral circulation.On clinicalobservation,ECP therapy showed marked alleviation or even subsidence of sympotmsincluding headache and dizziness in 10 of 12 cases of cerebral arteriosclerosis,and considera-ble improvement in 5 of 8 cases of Parkinsonism.Thus,ECP is a promising method inthe treatment of diseases caused by insufficiency of cerebral blood supply.
《Journal of Medical Biomechanics》2007-01
Modeling and simulation of effect on cerebral arterial blood flow with external counterpulsation
WANG Huai-yang~1 ZHENG Zhen-sheng~2. (1.College of Information Science and Technology,Ocean University of China,Qingdao 266071,China; 2.Assisted Circulation Laboratory,Sun Yat-sen University,Guangzhou 510089,China)
OBJECTIVE: To study the effect of external counterpulsation on cerebral blood flow,
METHODS: Cerebral blood flows were simulated on hemodynamics models of cerebral blood on condition of normal and stroke with practical measured normal carotid blood pressure pre-ECP and during ECP,
RESULTS: stroke and ECP may bring change of blood perfusion flow of brain.
CONCLUSION: the blood perfusion of brain was improved and the time-dependent pattern of time- dependent cerebral arterial blood was changed with ECP.
《Journal of Chongqing Medical University》2008-01
Effect of enhanced external counterpulsation on serum nitric oxide, malondialdehyde and superoxide dismutase in patients with coronary heart disease
XIAO Hua,et al(Department of Cardiology,the First Affiliated Hospital,Chongqing Medical University)
OBJECTIVE: To investigate the effect of enhanced external Counterpulsation (EECP) on serum nitric oxide (NO),malondialdehyde(MDA) and superoxide dismutase(SOD) in patients with coronary heart disease(CHD) and its mechanism.
METHODS: The serum NO,MDA and SOD levels of 54 cases of CHD and 20 normal controls were tested. Patients were divided into EECP group(30cases) and medication group(24 cases).The serum concentrations of NO,MDA and SOD of each group before and after treatment were compared for the correlation analysis.
RESULTS: Before treatment,compared with the normal controls,the serum levels in CHD patients were as follows.NO were much lower(P0.05),MDA were much higher(P0.01),and SOD were much lower(P0.05).After 6 weeks medication treatment or 3 courses EECP treatment,compared with the levels before treatment,the serum levels in CHD patients EECP group were as follows.NO increased significantly(P0.05),MDA decreased significantly(P0.05),and SOD increased significantly(P0.05);while there was only slight changes of NO,MDA and SOD in medication group without significant difference(P0.05).Correlation analyses showed that in EECP group,there was negative correlation between NO and SOD(r=-0.47,P0.01);positive correlation between NO and SOD(r=0.39,P0.05);negative correlation between MAD and SOD(r=-0.41,P0.05).
CONCLUSION: The blood vessel endothelium function was disordered and lipid peroxidation was enhanced in CHD patients.EECP treatment can regulate blood vessel endothelium function by improving the release of NO and relieve lipid peroxidation by reducing the production of MDA or increasing the production of SOD. The results may be useful in further study of EECP mechanism of treating CHD.
Acta Neurol Scand. 2003 Jun;107(6):405-11.
Changes of cerebral blood flow velocities during enhanced external counterpulsation.
Werner D, Marthol H, Brown CM, Daniel WG, Hilz MJ.
Source: Department of Cardiology, Friedrich-Alexander-University, Erlangen-Nuremberg, Germany. email@example.com
OBJECTIVES: Intra-aortic counterpulsation is the most frequently used cardiac assist device. However, there are only few studies of the effects of counterpulsation on cerebral blood flow and these report conflicting outcomes. The new enhanced external counterpulsation (EECP) technique reproduces non-invasively the effects of intra-aortic counterpulsation. In this study, we evaluated effects of EECP on blood pressure (BP) and on cerebral flow velocity (CBFV).
SUBJECTS AND METHODS: Twenty-three healthy controls and 15 atherosclerotic patients each underwent a 5-min session of EECP. Before, during and after EECP we monitored heart rate, beat-to-beat radial artery BP and CBFV.
RESULTS: EECP induced a second increase in BP and CBFV during diastole with a significant increase of mean BP and a decrease of systolic BP in patients and controls. Mean CBFV increased in both groups during the first 5 s of EECP. After 3 min of EECP, diastolic CBFV was still higher than at baseline, but systolic CBVF was lower than at baseline; mean CBFV was as low as before EECP in the patients and lower than the baseline values in the controls. Three minutes after ending EECP, mean and systolic BP were lower in the patients than the corresponding baseline values. Otherwise, CBFV and BP values did not differ from baseline in patients and controls.
CONCLUSION: Cerebral autoregulation ensures the constancy of cerebral blood flow even though EECP creates marked systemic changes. In the patients, the decrease of BP after EECP with maintained CBFV indicates an improved BPCBFV relation and a more economic autoregulation.
PMID: 12757472 [PubMed – indexed for MEDLINE]
Acta Neurol Scand. 2005 Jan;111(1):34-41.
Enhanced external counterpulsation does not compromise cerebral autoregulation.
Marthol H, Werner D, Brown CM, Hecht M, Daniel WG, Hilz MJ.
Source; Department of Neurology, University of Erlangen-Nuremberg, Erlangen, Germany.
OBJECTIVES: Enhanced external counterpulsation (EECP) rhythmically augments blood pressure (BP) by diastolic lower-body compression. Recently, we showed decreased mean cerebral blood flow velocity (CBFVmean) in young healthy persons during EECP, but unchanged CBFVmean in atherosclerotic patients. In this study, we assessed EECP effects on dynamic cerebral autoregulation (CA).
MATERIAL & METHODS: In 23 healthy persons and 15 atherosclerotic patients we monitored heart rate (HR), mean BP (BPmean) and CBFVmean before and during 5 min EECP. We analyzed spectral powers of HR, BPmean and CBFVmean in the low (LF: 0.04-0.15 Hz) and high (HF: 0.15-0.5 Hz) frequency ranges to determine CA from the LF-transfer function gain and phase shift between BPmean and CBFVmean oscillations.
RESULTS: EECPincreasedHR and BPmean, while transfer function gain and phase shift remained stable.
CONCLUSIONS: Stable gain and phase values suggest that EECPdoes not compromise CA and, therefore, does not seem to bear cerebrovascular risks.
Blackwell Munksgaard 2004 PMID: 15595936 [PubMed – indexed for MEDLINE]