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Pulsatile versus nonpulsatile blood flow in the treatment of acute cerebral ischemia.

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 less than 0.01), when perfusion was changed from nonpulsatile flow (pulse pressure less than 4mm 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 less than 0.01), when perfusion was changed from nonpulsatile (pulse pressure less than 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 less than 0.01) with pulsatile perfusion. These data demonstrate the importance of pulsatile blood flow in ischemic brain.