1.6 DETRIMENTAL EFFECTS ON CAROTID PERFUSION OF INTRA-AORTIC BALLOON PUMP SUPPORT

Abstract

Introduction: Intra-aortic balloon pumping is widely used to augment diastolic coronary perfusion. However, far less is known about its effects on other large arteries. In this study we assessed the effects of intra-arterial balloon pump pressure support on pressure and flow in the proximal aorta, carotid, coronary and renal arteries. Methods: Recordings of simultaneous pressure and flow velocity were made using intra-arterial sensor tipped wires. Velocity time integral (VTI) was calculated at each location. Results: With balloon pump support VTI increased in the coronary arteries (458 to 540cm, 15%). In contrast, in the carotid arteries VTI markedly decreased (278 to 228cm, −21%). VTI remained constant in the renal arteries (247cm) and the aorta (225cm). The detrimental reduction in carotid VTI was due to the sudden fall in pressure occurring with balloon deflation, which results in carotid velocity transiently becoming negative (Fig. 1). Figure 1Pressure and velocity in the carotid artery before (left) and during (right) intra-arterial balloon pump support. Conclusion: Intra-arterial balloon pumping augments coronary blood flow, at the expense of diminishing carotid blood flow. This could lead to cerebral insufficiency in patients with obstructive carotid disease.