There are an estimated 6.8 million Americans over 20 years old who have had a stroke, and 795,000 people experience a new or recurrent stroke every year.
Recently, there were several papers published to discuss the effects of using External Counterpulsation (ECP) therapy to treat ischemic stroke patients with cerebral large artery disease. The effects of ECP as a treatment of acute stroke has been demonstrated to increase cerebral blood pressure and blood flow velocity in stroke patients previously. ECP has been used extensively to help functional recovery of ischemic stroke patients in China, even though it has not been cleared by FDA for treatment of this cohort of patients in the United States.
In brief, these papers have the following message:
- The first paper analyzed 207 ischemic stroke patients, with 112 patients completed the 35 hour session of ECP, 43 did not, and 52 medical treated patients served as controls. Three months after a stroke, 70.5% of the patients who finished a whole course of EECP had a good clinical outcome, whereas only 46.5% achieved good outcome in the unfinished ECP group and 38.5% in the medical group. Patients with good clinical outcome were younger, had a lower baseline National Institute of Health Stroke Scale and longer ECP therapy. The paper concluded that the duration of ECP therapy is an important factor for a good clinical outcome.
- The second paper published demonstrated that ECP treatment increased cerebral blood pressure significantly as well as blood flow velocity in both sides of the brain in 37 recent ischemic stroke patients with large artery occlusive disease but not in the 20 healthy controls. The study demonstrated that ECP can increase blood flow to both sides of the cerebral hemisphere presumably because the cerebral autoregulation was impaired soon after stroke.
- The third paper published investigated the relationship between the magnitudes of external applied pressures during ECP, resulting in increased cerebral perfusion pressures and increased mean cerebral blood flow in 38 ischemic stroke patients and 20 elderly controls. The mean blood pressure increased significantly from baseline in both stroke and control groups in proportion to external applied pressure, whereas the mean cerebral blood flow increased to the same levels of around 5% above baseline in the stroke patients independent of the external applied pressure. Also, there were no changes in blood flow in the control group under different magnitudes of external applied pressure. The paper recommended 150 mm Hg as the optimal treatment pressure for ischemic stroke patients.
Dr. John CK Hui of Vasomedical remarked: “It has been postulated for decades that increase in cerebral perfusion blood pressure and blood flow would improve the functional recovery rate of stroke patients. These recent papers provided evidence that ECP treatment within the first two weeks after stroke when the autoregulatory response is inactive is safe and effective in augmenting cerebral blood pressure and flow. Results of these studies were encouraging and they stimulate us to start developing protocols for studies to seek FDA labeling clearance for stroke patients.”