Pulsatile versus Nonpulsatile Blood Flow in the Treatment of Acute Cerebral Ischemia

Abstract
The effects of pulsatile and nonpulsatile perfusion on local cerebral blood flow (CBF) and on computerized mapping (CME) of electroencephalograms (EEG) in nonischemic and ischemic brain were studied using a canine stroke model. Nine anesthetized mongrel dogs were placed on normothermic right atrial-femoral artery cardiopulmonary bypass at a flow of 100 ml/kg/minute. Local CBF measurements and CME data were collected during nonpulsatile perfusion and maximal pulsatile perfusion. The stroke model was then produced, and local CBF measurements and CME data were again collected during nonpulsatile and pulsatile perfusion. In the nonischemic brain, local CBF increased 19%, from 32 ± 10 to 38 ± 11 ml/100 g/minute (P < 0.01), when perfusion was changed from nonpulsatile flow (pulse pressure < 4 mm Hg) to pulsatile flow (pulse pressure 39 ± 11 mm Hg). In the ischemic brain, local CBF increased 55%, from 11 ± 5 to 17 ± 7 ml/100 g/minute (P < 0.01), when perfusion was changed from nonpulsatile (pulse pressure < 3 mm Hg) to pulsatile (pulse pressure 36 ± 7) flow. EEG power data, expressed as a power ratio index (PRI = low frequency power/high frequency power), improved significantly, from 110 ± 33 to 101 ± 41 (P < 0.01) with pulsatile perfusion. These data demonstrate the importance of pulsatile blood flow in ischemic brain.