Abstract
Purpose: We aimed to investigate whether external counterpulsation (ECP) may enhance endothelial metabolic and neurogenic activity by analyzing cerebral blood flow oscillation in transcranial Doppler (TCD) signals, and propose a new indicator for quantifying the enhancement. Methods: Twenty-seven patients with unilateral ischemic stroke in the anterior circulation territory (15 ones with 35 daily 1 h ECP treatment sessions and 12 ones without ECP treatment) were recruited. TCD monitoring of bilateral middle cerebral arteries was performed before and after ECP at day 1 and week 7. The index I, for quantitatively evaluating the enhancement of endothelial metabolism and neurogenic activity, was defined as the ratio of the oscillation amplitude of TCD signal in the dedicated frequency interval at different time points with wavelet analysis. TCD data were analyzed using wavelet analysis based on ipsilateral or contralateral to the infarct side. An overall change in National Institutes of Health Stroke Scale (NIHSS) and Barthel Index (BI) scores were recorded. Results: The index I at baseline of week 7 compared with day 1 were significantly higher on both ipsilateral and contralateral sides in ECP group (ipsilateral, 1.28±0.30; contralateral, 1.28±0.30) than those in No-ECP group (ipsilateral, 1.02±0.06; contralateral, 1.00±0.06) (all P <0.05). The I during ECP of week 7 compared with day 1 also increased on both sides in ECP group (ipsilateral, 1.31±0.36; contralateral, 1.29±0.34) than those in No-ECP group (ipsilateral, 0.99±0.06; contralateral, 1.00±0.07) (all P <0.05). There were positive correlations of I with favorable changes in NIHSS and BI in ECP group. Conclusions: ECP treatment can enhance endothelial metabolic and neurogenic activity. The index I may be used as an indicator of enhancement of endothelial metabolic and neurogenic activity, as well as clinical outcome, in ischemic stroke following ECP treatment.
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