Improved neurological recovery of cerebral infarctions after plasmapheretic reduction of lipids and fibrinogen.

Walzl, Manfred; Lechner, H.; Walzl, B.; Schied, G

doi:10.1161/01.str.24.10.1447

Cited by 43 publications

(23 citation statements)

References 9 publications

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“…The present study extends our previous observations in patients with hyperfibrinogenemia who underwent the HELP procedure [7,8]: each HELP treatment produced an immediate and significant reduction in rheo logical measures including fibrinogen, the he morheologic pattern, and lipoproteins.…”

Section: Discussionsupporting

confidence: 89%

“…As demonstrated by foregoing studies, it might additionally be of interest that HELP was followed by statistically significant im provements in neuropsychological test batter ies [7,8]. The treated groups, suffering from…”

Section: Discussionmentioning

confidence: 95%

“…On the other hand, studies performed in cardiac patients [6] and those with cerebro vascular disease [7,8] reported that the hemorheologic pattern as well as clinical symp toms were ameliorated rapidly and safely by a treatment modality utilizing the heparin-in duced extracorporeal LDL/fibrinogen precip itation (HELP). Recently it has been shown that HELP even in patients with PAD can lead to an improvement of clinical symptoms.…”

Section: Introductionmentioning

confidence: 99%

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Increased Cerebral Perfusion following Reduction of Fibrinogen and Lipid Fractions

Walzl

Walzl²,

Valetitsch³

et al. 1995

Pathophysiol Haemos Thromb

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High levels of plasma fibrinogen in cerebrovascular disease cause deterioration in the hemorheologic pattern, microcirculation and cerebral perfusion. We compared the value of hepa-rin-induced extracorporeal LDL precipitation (HELP) which is a method that safely and effectively reduces plasma fibrinogen and lipoproteins and so improves the hemorheologic pattern and blood flow properties. Regional cerebral blood flow (rCBF) was measured by the ¹³³Xe SPECT clearance method. After first measuring rCBF, 15 patients suffering from cerebral multi-infarct disease underwent a single HELP application. One hour later a second measurement of rCBF was performed. Fifteen other patients with similar clinical symptoms and findings on CAT scans who were not subjected to HELP served as controls. The HELP treatment produced an immediate and statistically significant reduction of all parameters relevant to hemorheology, such as plasma fibrinogen, whole blood viscosity at both high and low shear rate, plasma viscosity, and red cell transit time. Total cholesterol, low density lipo-protein, and triglycerides were also reduced. The treated group showed 9.7-19.9% increased rCBF in different vascular regions examined relative to the untreated controls. The results obtained indicate that HELP has a potent effect in a situation demanding rapid and significant improvement of the blood flow.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 95%

Section: Introductionmentioning

confidence: 99%

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Increased Cerebral Perfusion following Reduction of Fibrinogen and Lipid Fractions

Walzl

Walzl²,

Valetitsch³

et al. 1995

Pathophysiol Haemos Thromb

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“…24,29,30 There are currently no comparable studies in the literature. 31 Rubba et al 29 demonstrated an increase in blood flow velocities in transcranial Doppler after LDL apheresis in patients with familial hypercholesterolemia that they attributed to the restoration of endotheliummediated vasodilation, which is inhibited by a high concentration of LDLs.…”

Section: Discussionmentioning

confidence: 99%

Extracorporeal Rheopheresis in the Treatment of Acute Ischemic Stroke

Berrouschot

Barthel

Köster

et al. 1999

Stroke

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Background and Purpose-Extracorporeal rheopheresis is a safe method to optimize hemorheology. Our aim was to determine whether treatment with extracorporeal rheopheresis in patients with acute ischemic hemispheric stroke improves cerebral perfusion as assessed with serial 99m Tc-ethyl-cysteinate-dimer single-photon emission CT ( 99m Tc-ECD SPECT). We also investigated how clinical outcome is associated with treatment and imaging results. Methods-Thirty-three patients (mean age, 64Ϯ10 years) with acute ischemic hemispheric stroke were included in a prospective, randomized, parallel group pilot study. First treatment with or without extracorporeal rheopheresis took place within 12 hours after the onset of symptoms and was repeated 3 times at intervals of 24 hours. Hemorheological parameters were measured before and after each session. Each patient underwent 99m Tc-ECD SPECT immediately before treatment, 6 to 8 hours after treatment, and after 5 days. A semiquantitative SPECT graded scale was used to measure depth and extent of activity deficits and thus to quantify the perfusion deficit. Results-Seventeen patients were actively treated with extracorporeal rheopheresis, and 16 patients did not receive extracorporeal rheopheresis. After 3 months, no differences were found in the functional or neurological outcome. Despite a rapid, sustained decrease of plasma viscosity and erythrocyte aggregation in the rheopheresis group, there was no significant difference in the SPECT graded scale after therapy between the 2 groups. Patients with early reperfusion (decrease in the SPECT graded scale Ͼ25% 6 to 8 hours after therapy compared with the baseline examination) experienced a better functional outcome (Modified Rankin Scale) after 3 months compared with patients without reperfusion (Pϭ0.04). Conclusions-Since quantitative flow mapping and clinical follow-up did not reveal any differences between patients who were treated with extracorporeal rheopheresis and controls, it appears very unlikely that extracorporeal rheopheresis enhances reperfusion after acute cerebral ischemia. (Stroke. 1999;30:787-792.)

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“…Walzl et al [57] studied 26 patients with acute embolic stroke and 22 patients with multi-infarct dementia to determine whether reduction of fibrinogen and lipid factors produced improved rheologic properties of blood and improved clinical function in CVD. Using the HELP system, each group of patients received two treatments within 8 days.…”

Section: Cognitive Functionmentioning

confidence: 99%

Low-density lipoprotein apheresis in the treatment of atherosclerosis and other potential uses

Moriarty

Gibson

2001

Curr Atheroscler Rep

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This review concerns the clinical impact of low-density lipoprotein (LDL) apheresis for patients with refractory hypercholesterolemia. We examine and provide examples of investigations that have demonstrated the clinical benefits of LDL apheresis. In addition to benefits derived from the stabilization or regression of arterial lesions, we highlight other possible mechanisms related to clinical improvement. We also discuss the potential advantages of lipid apheresis for the treatment of patient populations other than those characterized by severe hypercholesterolemia and premature coronary heart disease.

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Improved neurological recovery of cerebral infarctions after plasmapheretic reduction of lipids and fibrinogen.

Cited by 43 publications

References 9 publications

Increased Cerebral Perfusion following Reduction of Fibrinogen and Lipid Fractions

Increased Cerebral Perfusion following Reduction of Fibrinogen and Lipid Fractions

Extracorporeal Rheopheresis in the Treatment of Acute Ischemic Stroke

Low-density lipoprotein apheresis in the treatment of atherosclerosis and other potential uses

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