Lylyk Pedro, Vila José F, Miranda Carlos, Ferrario Angel, Romero Ricardo, Cohen José E
Department of Neurosurgery, Endovascular Neurosurgery and Interventional Neuroradiology, ENERI Clínica Médica Belgrano Buenos Aires, Argentina.
Neurol Res. 2005;27 Suppl 1:S129-35. doi: 10.1179/016164105X35512.
Stroke studies in animals showed that aortic obstruction increases cerebral blood flow (CBF) and reduces infarct size. In this study we evaluate the safety and efficacy of a device providing partial and transitory aortic obstruction.
We report the results in 24 selected patients with symptomatic vasospasm by aneurysmal subarachnoid hemorrhage treated by partial and transitory aortic obstruction with a novel device (NeuroFlo, CoAxia, MN). Aneurysms were secured by coils prior to the procedure. We studied the adverse effects related to the aorta-obstructing device, and changes in CBF and neurological outcome.
Mean flow velocity increased in both middle cerebral arteries over 15%, and the score in the National Institute of Health Stroke Scale decreased >or=2 point in 20 patients (83%). During the procedure, three patients developed symptoms that were controlled. At 30 days follow-up, three patients had 6 points (unrelated death), three had 3 points, six had 1 point, and 12 had 0 points, in the modified Rankin scale.
Partial aortic obstruction was safe, the cerebral blood flow increased without inducing significant hypertension and the neurological defects improved in most of the patients. Efficacy with a better level of evidence will be determined by a randomized study.
动物中风研究表明，主动脉阻塞可增加脑血流量（CBF）并减小梗死灶大小。在本研究中，我们评估了一种提供部分性和暂时性主动脉阻塞的装置的安全性和有效性。
我们报告了24例经新型装置（NeuroFlo，CoAxia，MN）进行部分性和暂时性主动脉阻塞治疗的症状性动脉瘤性蛛网膜下腔出血所致血管痉挛患者的结果。在手术前用弹簧圈固定动脉瘤。我们研究了与主动脉阻塞装置相关的不良反应，以及脑血流量和神经功能结局的变化。
双侧大脑中动脉的平均血流速度增加超过15%，20例患者（83%）的美国国立卫生研究院卒中量表评分降低≥2分。在手术过程中，3例患者出现的症状得到了控制。在30天随访时，改良Rankin量表中，3例患者得6分（非相关性死亡），3例得3分，6例得1分，12例得0分。
部分性主动脉阻塞是安全的，脑血流量增加且未诱发明显高血压，大多数患者的神经功能缺损得到改善。更高证据水平的有效性将通过一项随机研究来确定。
