Department of Interventional Neuroradiology and Neurosurgery, Columbia University Medical Center, New York, NY, USA.
Neurocrit Care. 2010 Dec;13(3):385-8. doi: 10.1007/s12028-010-9442-2.
Delayed ischemic neurological deficits (DIND) due to cerebral vasospasm remains a major cause of morbidity and mortality following aneurysmal subarachnoid hemorrhage (aSAH). Methods to prevent DIND remain limited both in safety and efficacy. A novel intra-aortic dual balloon catheter (NeuroFlo™: CoAxia, Maple Grove, MN) is under investigation for treatment of ischemic stroke, including DIND. Because this technique does not require cerebral artery navigation, it may be useful as a bedside procedure, outside of the conventional angiography suite. We report the first case of ultrasound-guided application of the NeuroFlo™ system at bedside in the Neurological Intensive Care Unit.
A 52-year-old woman presented with Hunt Hess IV aSAH complicated by medically refractory cerebral vasospasm. Despite surgical clipping of her aneurysm, the patient remained critically ill, failing maximal conventional medical therapy. For that reason, the NeuroFlo™ system was deployed using two-dimensional, spectral and color-flow Doppler ultrasound guidance at the patient's bedside while maintaining all forms of cerebral blood flow monitoring.
The procedure was well tolerated and there was no complication.
Bedside application of the NeuroFlo™ system may be safely performed in critically ill patients. The NeuroFlo™ system is under investigation for treatment of refractory cerebral vasospasm to prevent delayed ischemic neurological disease.
由于脑动脉痉挛导致的迟发性缺血性神经功能缺损（DIND）仍然是蛛网膜下腔出血（aSAH）后发病率和死亡率的主要原因。预防 DIND 的方法在安全性和疗效方面都很有限。一种新型的主动脉内双球囊导管（NeuroFlo ™：CoAxia，Maple Grove，MN）正在研究用于治疗缺血性卒中，包括 DIND。由于这种技术不需要进行脑血管导航，因此它可能作为一种床边程序在常规血管造影术室之外使用。我们报告了首例在神经重症监护病房床边使用 NeuroFlo ™系统进行超声引导的应用。
一名 52 岁女性因 Hunt Hess IV 型 aSAH 并发药物难治性脑动脉痉挛而就诊。尽管对她的动脉瘤进行了手术夹闭，但患者仍处于危急状态，对最大常规药物治疗无反应。因此，在床边使用二维、频谱和彩色血流多普勒超声引导对患者进行了 NeuroFlo ™系统部署，同时保持了所有形式的脑血流监测。
该过程耐受良好，无并发症发生。
床边应用 NeuroFlo ™系统在危重病患者中是安全的。NeuroFlo ™系统正在研究用于治疗难治性脑动脉痉挛以预防迟发性缺血性神经疾病。
