Bedside Use of a Dual Aortic Balloon Occlusion for the Treatment of Cerebral Vasospasm

Delayed ischemic neurological deficits (DIND) due to cerebral vasospasm remains a major cause of morbidity and mortality following aneurysmal subarachnoid hemorrhage (aSAH). Methods to prevent DIND remain limited both in safety and efficacy. A novel intra-aortic dual balloon catheter (NeuroFlo(TM): CoAxia, Maple Grove, MN) is under investigation for treatment of ischemic stroke, including DIND. Because this technique does not require cerebral artery navigation, it may be useful as a bedside procedure, outside of the conventional angiography suite. We report the first case of ultrasound-guided application of the NeuroFlo(TM) system at bedside in the Neurological Intensive Care Unit. A 52-year-old woman presented with Hunt Hess IV aSAH complicated by medically refractory cerebral vasospasm. Despite surgical clipping of her aneurysm, the patient remained critically ill, failing maximal conventional medical therapy. For that reason, the NeuroFlo(TM) system was deployed using two-dimensional, spectral and color-flow Doppler ultrasound guidance at the patient's bedside while maintaining all forms of cerebral blood flow monitoring. The procedure was well tolerated and there was no complication. Bedside application of the NeuroFlo(TM) system may be safely performed in critically ill patients. The NeuroFlo(TM) system is under investigation for treatment of refractory cerebral vasospasm to prevent delayed ischemic neurological disease.