Preliminary findings of external counterpulsation for ischemic stroke patient with large artery occlusive disease

Background and Purpose - We aimed to investigate the feasibility and therapeutic effect of external counterpulsation ( ECP) in ischemic stroke. Methods - The trial was a randomized, crossover, assessment- blinded, proof- of- concept trial. ECP treatment consisted of 35 daily 1- hour sessions. Patients were randomized to either early ( ECP weeks 1 to 7 and no ECP weeks 8 to 14) or late group ( no ECP weeks 1 to 7 and ECP weeks 8 to 14). Primary outcomes were an overall change in National Institutes of Health Stroke Scale ( NIHSS) and cerebral blood flow estimated by color velocity imaging quantification. Secondary outcomes were change in NIHSS, color velocity imaging quantification, favorable functional outcome ( modified Rankin scale, 0 to 2), and stroke recurrence at weeks 7 and 14, respectively. Results - Fifty patients were recruited. At week 7, there was a significant change in NIHSS ( early 3.5 vs late 1.9; P = 0.042). After adjusting for treatment sequence, ECP was associated with a favorable trend of change in NIHSS of 2.1 vs 1.3 for non- ECP ( P = 0.061). Changes of color velocity imaging quantification were not significant but tended to increase with ECP. At week 14, a favorable functional outcome was found in 100% of early group patients compared to 76% in the late group ( P = 0.022). Conclusion - ECP is feasible for ischemic stroke patients with larger artery disease.