Abstract

Partial aortic occlusion in pre-clinical research has shown a 30% increase in cerebral perfusion with minimal increase in central blood pressure. Treatment involves placement of a catheter (NeuroFloTM, CoAxia) in the descending aorta, sequential inflation of two independently controlled balloons in the infra- and supra-renal positions, each to 70% luminal occlusion, for 45 min. The proposed mechanism of action involves cerebral collateral recruitment and salvage of penumbral tissue. Within the multi-center randomized SENTIS trial, this technique was applied at our institutions to 23 consecutive acute ischemic strokes up to 14 h from onset that were not eligible for IV tPA or intravascular recanalization. Patients underwent baseline and treatment perfusion imaging and were followed for 90 day neurological and functional outcome results. The 23 patients averaged 9.2 h to randomization with an average NIHSS=10.7 of 10 treated patients (70%) achieved a 90 day mRS 0-2 vs 4 of 13 untreated patients (31%). 4 out of 5 treated patients with non-zero mismatch on baseline perfusion scans showed significant reduction in mismatch volume after treatment. Possible differences explaining the significantly greater success in our patients from the general SENTIS trial were our institution's inclusion criteria of the lack of CBV lesions (completed strokes) or first order CTA occlusions. We found augmented cerebral perfusion in acute ischemic stroke with the NeuroFlo catheter to be easy, safe and effective in our subset of patients.