Weber Garret M, Gass Alan L, Parikh Shalvi B
Department of Anesthesiology, Westchester Medical Center, Valhalla, NY 10595, USA.
Cardiac Transplantation and Mechanical Circulatory Support, Westchester Medical Center, Valhalla, NY 10595, USA.
Case Rep Med. 2017;2017:5043471. doi: 10.1155/2017/5043471. Epub 2017 Jul 27.
Intra-aortic balloon pump (IABP) counterpulsation is a catheter-based treatment for coronary artery disease and decompensated heart failure to increase coronary blood flow and improve cardiac output. IABP is generally well tolerated, and complications are usually related to peripheral vasculature or red blood cell and platelet consumption. The usual insertion site via femoral artery renders the patient bedbound. Recently, axillary artery has been used in patients with atherosclerotic peripheral vascular disease and documented small arteries or in those awaiting transplant to ensure ambulation and prevent deconditioning.
We present a patient with ischemic cardiomyopathy and severe left ventricular dysfunction, awaiting Orthotropic Heart Transplant. His worsening intractable angina and dyspnea necessitated IABP placement via left axillary artery, significantly improving his condition. He subsequently experienced migraine-type persistent unilateral headache refractory to standard pain management. Multiple strategies were utilized to treat his pain, but the patient insisted that his pain commenced after IABP placement. Ultimately, the removal of the pump led to complete resolution with no recurrence.
The authors hypothesize that the unilaterally directed blood flow and direct increase in cerebral perfusion from the intra-aortic balloon pump may have caused vasodilation of the extracranial arteries, leading to a persistent and debilitating headache in this susceptible patient.
主动脉内球囊反搏（IABP）是一种基于导管的治疗冠状动脉疾病和失代偿性心力衰竭的方法，可增加冠状动脉血流并改善心输出量。IABP一般耐受性良好，并发症通常与外周血管系统或红细胞及血小板消耗有关。经股动脉的常规插入部位会使患者卧床不起。最近，腋动脉已被用于患有动脉粥样硬化外周血管疾病且记录有小动脉的患者或等待移植的患者，以确保其能行走并防止身体机能下降。
我们介绍一位患有缺血性心肌病和严重左心室功能障碍、等待原位心脏移植的患者。他日益加重的顽固性心绞痛和呼吸困难使通过左腋动脉放置IABP成为必要，这显著改善了他的病情。随后，他经历了偏头痛型持续性单侧头痛，对标准疼痛管理无效。我们采用了多种策略来治疗他的疼痛，但患者坚称他的疼痛在放置IABP后开始。最终，移除球囊泵后疼痛完全缓解且未复发。
作者推测，主动脉内球囊泵单向的血流以及脑灌注的直接增加可能导致了颅外动脉血管扩张，从而在这位易感患者中引发了持续性且使人衰弱的头痛。
