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 540 cm, 15%). In contrast, in the carotid arteries VTI markedly decreased (278 to 228 cm, -21%). VTI remained constant in the renal arteries (247 cm) and the aorta (225 cm). 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).

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.