Cerebral Augmentation Effect Induced by External Counterpulsation Is Not Related to Impaired Dynamic Cerebral Autoregulation in Ischemic Stroke

 No clue, but some definitions here:

External counterpulsation (ECP), commonly referred to as enhanced external counterpulsation, is a noninvasive outpatient treatment for coronary artery disease refractory to medical and/or surgical therapy. Although ECP devices are cleared by the Food and Drug Administration (FDA) for use in treating a variety of cardiac conditions, including stable or unstable angina pectoris, acute myocardial infarction and cardiogenic shock, the use of this device to treat cardiac conditions other than stable angina pectoris is not covered, since only that use has developed sufficient evidence to demonstrate its medical effectiveness. Non-coverage of hydraulic versions of these types of devices remains in force.

AUGMENTATION INDEX IS A PREDICTOR OF CEREBRAL BLOOD FLOW ACROSS GLOBAL GRAY MATTER IN THE ELDERLY

 The latest here:

Cerebral Augmentation Effect Induced by External Counterpulsation Is Not Related to Impaired Dynamic Cerebral Autoregulation in Ischemic Stroke

Li Xiong^1,2*, Xiangyan Chen^3*, Jia Liu⁴, Lawrence Ka Sing Wong² and Thomas W. Leung²

• ¹Clinical Trials Centre, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, China
• ²Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
• ³Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Shatin, Hong Kong SAR, China
• ⁴Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China

Background and Purpose: Dynamic cerebral autoregulation is impaired after ischemic stroke. External counterpulsation (ECP) augments the cerebral blood flow of patients with ischemic stroke by elevation of blood pressure (BP). We aimed to investigate if cerebral augmentation effects during ECP were associated with impaired dynamic cerebral autoregulation in patients after acute ischemic stroke.

Methods: Forty patients with unilateral ischemic stroke and large artery atherosclerosis in the anterior circulation territory within 7 days from symptom onset and eighteen healthy controls were recruited. We monitored changes in mean flow velocity over both middle cerebral arteries (MCA) by transcranial Doppler (TCD) before, during, and immediately after ECP. Cerebral augmentation index was MCA mean flow velocity increase in percentage during ECP compared with baseline to evaluate the augmentation effects of ECP. Spontaneous arterial BP and cerebral blood flow velocity in both bilateral MCAs were recorded using a servo-controlled plethysmograph and TCD, respectively. Transfer function analysis was used to derive the autoregulatory parameters, including phase difference (PD), and gain.

Results: The cerebral augmentation index in patients with stroke was significantly higher on both the ipsilateral and contralateral sides than that in controls, while the PD in patients with stroke was significantly lower on both sides than those in controls (all P < 0.05). The cerebral augmentation index did not correlate with PD and gain on either the ipsilateral or contralateral side of patients with stroke or in controls (all P > 0.05). The cerebral augmentation index of patients with stroke was significantly related to mean BP change on the ipsilateral side (R² = 0.108, P = 0.038).

Conclusion: The degree of ECP-induced cerebral augmentation effects as measured by the cerebral augmentation index did not correlate with the magnitude of impaired dynamic cerebral autoregulation.

 

Perfusion augmentation in acute stroke using mechanical counter-pulsation-phase IIa: effect of external counterpulsation on middle cerebral artery mean flow velocity in five healthy subjects

Well hell, why test in healthy subjects? Only 10 years old, ask your doctor if any followup was done and what the protocol is for stroke patients.
https://www.ncbi.nlm.nih.gov/pubmed/18658038
Stroke. 2008 Oct;39(10):2760-4. doi: 10.1161/STROKEAHA.107.512418. Epub 2008 Jul 24.

Alexandrov AW¹, Ribo M, Wong KS, Sugg RM, Garami Z, Jesurum JT, Montgomery B, Alexandrov AV.

Author information

Abstract

BACKGROUND AND PURPOSE:

External counterpulsation (ECP) improves coronary perfusion, increases left ventricular stroke volume similar to intraaortic balloon counterpulsation, and recruits arterial collaterals within ischemic territories. We sought to determine ECPs effect on middle cerebral artery (MCA) blood flow augmentation in normal controls as a first step to support future clinical trials in acute stroke.

METHODS:

Healthy volunteers were recruited and screened for exclusions. Bilateral 2-MHz pulsed wave transcranial Doppler (TCD) probes were mounted by head frame, and baseline M1 MCA TCD measurements were obtained. ECP was then initiated using standard procedures for 30 minutes, and TCD readings were repeated at 5 and 20 minutes. Physiological correlates associated with ECP-TCD waveform morphology were identified, and measurable criteria for TCD assessment of ECP arterial mean flow velocity (MFV) augmentation were constructed.

RESULTS:

Five subjects were enrolled in the study. Preprocedural M1 MCA TCD measurements were within normal limits. Onset of ECP counterpulsation produced an immediate change in TCD waveform configuration with the appearance of a second upstroke at the dicrotic notch, labeled peak diastolic augmented velocity (PDAV). Although end-diastolic velocities did not increase, both R-MCA and L-MCA PDAVs were significantly higher than baseline end-diastolic values (P<0.05 Wilcoxon rank-sum test) at 5 and 20 minutes. Augmented MFVs (aMFVs) were also significantly higher than baseline MFV in the R-MCA and L-MCA at both 5 and 20 minutes (P<0.05).

CONCLUSIONS:

ECP induces marked changes in cerebral arterial waveforms and augmented peak diastolic and mean MCA flow velocities on TCD in 5 healthy subjects.

PMID:

18658038

DOI:

10.1161/STROKEAHA.107.512418

External Counter Pulsation ECP / EECP provides a new method of cerebral perfusion improvement with collateral supply in ischemic stroke having artery occlusive disease as reported by doctors of Department of Medicine and Therapeutics, Chinese University of Hong Kong and Prince of Wales Hospital.

Ask your doctor.
http://info.sibiamedicalcentre.com/ECP-benefit-Brain-stroke-patients-External-Counter-Pulsation-ECP-EECP-provides-a-new-method-of-cerebral-perfusion-improv/b1652?
ECP benefit Brain stroke patients

External Counter Pulsation ECP / EECP provides a new method of cerebral perfusion improvement with collateral supply in ischemic stroke having artery occlusive disease as reported by doctors of Department of Medicine and Therapeutics, Chinese University of Hong Kong and Prince of Wales Hospital.
Flow velocity changes before, during, and after ECP were monitored in Ischemic stroke patients with infarcts for 3 minutes using transcranial Doppler. ECP significantly increased middle cerebral artery mean flow velocities of stroke patients with augmentation index of 9 percent.

“ Brain stroke p[atients have little hope. In my opinion patients with weakness of limbs, decreased memory and mental capacity should try ECP – it may improve their Quality of Life” says Dr Sibia.
-----------------------------------------------------------------------------
ECP/EECP was introduced in India by Dr. Sibia, Director, Sibia Medical Centre, Ludhiana
http://www.sibiamedicalcentre.com/

#EECP, #ECP, #ArteryClearanceTherapy #chelationtherapy #Avoidbypasssurgery #BestNonsurgicalCentre #SibiaMedicalcentre #ACT #Heartdisease #Treatments #besthearttreatmentclinicLudhianaPunjab

External counterpulsation enhances neuroplasticity to promote stroke recovery

Isn't your doctor already following these? Or not? Showing how fucking incompetent they and their hospital is?

Leg wraps raise hopes of saved lives after strokes May 2013 

Leg compressions may enhance stroke recovery August 2012

I bet your doctor and stroke hospital did nothing with them either and will do nothing with this.  

The latest here:

External counterpulsation enhances neuroplasticity to promote stroke recovery

Introduction

Improving tissue perfusion in peri-infarct cortex could enhance neuroplasticity and improve functional recovery after stroke.1 Treatments that enhance corticomotor function may benefit motor recovery. However, the effects of cerebral blood flow augmentation on corticomotor excitability have not been explored in humans.

External counterpulsation (ECP) is a non-invasive method to improve perfusion of vital organs.2 It operates by applying ECG-triggered pressure to the lower extremities during diastole by means of air-filled cuffs. The diastolic augmentation of blood flow and the reduction of systolic afterload increases blood flow to the heart, brain and kidneys. In patients who had ischaemic stroke, ECP enhances cerebral blood flow velocities and can be associated with improvement in the neurological outcome.3 ECP may improve cerebral perfusion and collateral blood supply in ischaemic stroke by augmenting blood pressure and cerebral blood flow velocity.4 The effects of ECP on corticomotor excitability are unknown. We aimed to explore the effects of ECP on corticomotor excitability and upper limb motor recovery. We hypothesised that enhancing cerebral blood flow with ECP will facilitate ipsilesional corticomotor excitability and improve upper limb performance at the subacute stage of recovery after ischaemic stroke.

Subjects and methods

First-ever ischaemic stroke patients with upper limb impairment with onset between 4 days and 21 days were enrolled. Exclusion criteria were cardioembolic stroke, sustained hypertension (systolic >180 mm Hg or diastolic >100 mm Hg), bleeding diathesis, vascular malformation, epilepsy, pregnancy, metal or electronic implants, severe head injury, severe systemic diseases and malignancy. Patients were randomised (1:1) to either real or sham ECP. ECP was performed using an ECP system (MC2, Vamed Medical Instrument Company, Foshan, China). Both groups completed 10 sessions of ECP for 1 hour per day, delivered over …

View Full Text

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Request permissions

Copyright information:

© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

External Counterpulsation Augments Blood Pressure and Cerebral Flow Velocities in Ischemic Stroke Patients With Cerebral Intracranial Large Artery Occlusive Disease

See what your doctor thinks of this compared to the  previous post that had differing arguments on hypertension post-stroke.
Previous post here;

Detrimental effect of blood pressure reduction in the first 24 hours of acute stroke onset

The counterpulsation one here;

http://stroke.ahajournals.org/content/43/11/3007.abstract 

Abstract

Background and Purpose—External counterpulsation (ECP) is a novel noninvasive method used to improve the perfusion of vital organs, which may benefit ischemic stroke patients. We hypothesized that ECP may augment cerebral blood flow of ischemic stroke patients via induced hypertension.

Methods—We recruited ischemic stroke patients with cerebral intracranial large artery occlusive disease and healthy elderly controls into this study. Bilateral middle cerebral arteries of subjects were monitored using transcranial Doppler. Flow velocity changes before, during, and after ECP were, respectively, recorded for 3 minutes while continuous beat-to-beat blood pressure data were recorded. Cerebral augmentation index was the increase in percentage of middle cerebral artery mean flow velocity during ECP compared with baseline. Transcranial Doppler data were analyzed based on ipsilateral or contralateral to the infarct side.

Results—ECP significantly increased mean blood pressure of stroke patients and controls. During ECP, middle cerebral artery mean flow velocities of stroke patients increased on both ipsilateral and contralateral sides when compared with baseline (ipsilateral cerebral augmentation index, 9.64%; contralateral cerebral augmentation index, 9%; both P<0.001), but there was no increase in difference between the 2 sides when compared with each other. Mean flow velocities of controls did not change under ECP. After ECP, blood pressure and flow velocity of stroke patients returned to baseline level.

Conclusion—ECP provides a new method of cerebral blood flow augmentation in ischemic stroke by elevation of blood pressure. Flow augmentation induced by ECP suggests the improvement of cerebral perfusion and collateral supply from infarct ipsilateral and contralateral sides.