Mohamed M. Ibrahim, Maher Saqqur, Arabesque Parker, Monica Saini, Dulka Manawadu, Ken Butcher, Derek Emery, Ashfaq Shuaib, Edmonton, AB, Canada
OBJECTIVE: Role of Transcranial Doppler (TCD) monitoring in acute stroke patients treated with NeuroFlo
device . BACKGROUND: The NeuroFlo device has been implemented as an experimental tool for potential interventional treatment in non- IV rt-PA responder patients with acute ischemic stroke. The presumed mechanism of action is enhancement of blood flow diversion to cerebral collaterals to minimise infarct volume and improve clinical outcomes. DESIGN/METHODS: Patients presenting to our ER with acute ischemic stroke, who did not show significant improvement after thrombolysis were screened; after an informed consent, they were enrolled in the Feasibility and Safety of NeuroFlo in Stroke Patients Receiving rt-PA. An intra-aortic balloon was inflated after completion of the rtPA infusion, resulting in the partial occlusion of abdominal Aorta for 45 minutes. TCD was performed at baseline, at the end of IV rt-PA treatment, before and during balloon inflation. RESULTS: We enrolled 9 cases, 4 patients did not had TCD study, of the remaining 5 patients 3 patients had MCA occlusion and 2 Terminal ICA occlusion. Three patients had good long term outcome Modified Rankin Scale (MRS) at 90 days were 1, zero and Zero respectively. There TCD during balloon inflation revealed: 1- Enhancing flow at the occlusion site (mean flow velocity increased from 18 to 24, 8 to 22 and 14 to 46 cm/sec) 2- Two patients had anterior cross filing developed through anterior communicating artery (ACom). 3- Enhancing flow through contralateral MCA (MFV 108 to 177 cm/sec) and ips ACA flow (MFV 22 to 81 cm/sec) in one patient. Two patients had poor outcome (MRS at 90 days 
3) both had no enhancing flow during balloon inflation. CONCLUSIONS/RELEVANCE: NeuroFlo
device might provide a new treatment for acute stroke patients beyond the 3 hours window by enhancing the flow at the occlusion site and opening up collateral flow. Category - Cerebrovascular Disease - Acute Stroke Therapy
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