Venous modulation of collateral perfusion of cerebral ischemia
A patient in whom blood diversion due to cerebral venous steal is present, and abolishment of the cerebral venous steal is indicated, is treated by increasing the cerebral venous pressure in the patient. This increase in cerebral venous pressure restores the collapsed cerebral vasculature, thereby increasing cerebral blood flow. The increase in cerebral venous pressure may be achieved using an occluding catheter in the superior vena cava or the internal jugular veins, using external compression of the cervical veins, or any other suitable mechanism. The occlusion may be controlled precisely during treatment, possibly as a function of cerebral blood flow, and after treatment the patient may experience a persistent effect because the cerebral vasculature is no longer collapsed.
1. A method for treating cerebral ischemia in a patient, the method comprising:
selecting a patient in whom blood diversion due to cerebral venous steal is present and abolishment of the cerebral venous steal is indicated, the cerebral venous steal caused by focally collapsed cerebral vasculature;
placing a cervical cuff externally around the patients neck;
increasing a cerebral venous pressure in the patient by inflating the cervical cuff and thereby occluding one or more veins coupled to the collapsed cerebral vasculature; and
adjusting inflation of the cervical cuff to an optimal occlusion level using parameters comprising cerebral blood flow (CBF), central venous pressure (CVP), cerebral perfusion pressure (CPP) and mean arterial pressure (MAP) at which regional cerebral blood flow (CBF) is optimized; and
maintaining the increased cerebral venous pressure at the optimal occlusion level for a period of time sufficient to restore at least a portion of the patient's collapsed cerebral vasculature and thereby treating the patient for cerebral ischemia.
2. The method of claim 1 , wherein the patient is suffering or has suffered from a stroke.
3. The method of claim 1 , wherein the one or more veins comprise a portion of the patients superior vena cava.
4. The method of claim 1 , wherein the one or more veins comprise a portion of the patients superior vena cava between the patient's right aorta and azygos vein.
5. The method of claim 1 , wherein the one or more veins comprise one or both of a patients interior jugular veins.
6. The method of claim 1 , wherein the method is non-invasive.
7. The method of claim 1 , further comprising:
mapping the cerebral blood flow and the venous pressure non-invasively while the increased cerebral venous pressure is being maintained; and
adjusting the increased venous pressure as a function of at least the cerebral blood flow non-invasively.
8. The method of claim 7 , wherein the increased venous pressure is adjusted until the optimal occlusion level is obtained.
9. The method of claim 7 , wherein the cerebral blood flow is mapped using transcranial doppler (TCD) waveforms.
10. The method of claim 1 , wherein cerebral blood flow heterogeneity and blood flow in ischemic areas of the patient's brain are maintained above the critical ischemic threshold.
11. The method of claim 1 , further comprising removing the occlusion cervical cuff from the one or more veins coupled to the collapsed cerebral vasculature.
12. The method of claim 1 , further comprising measuring venous pressure and regional cerebral blood flow (CBF) while the one or more veins are occluded.
13. The method of claim 12 , wherein the one or more veins comprise the patient's cervical veins.
14. The method of claim 12 , wherein the CBF is measured by applying transcranial doppler (TCD) waveforms.
15. The method of claim 12 , further comprising maintaining cerebral blood flow heterogeneity and blood flow in ischemic areas of the patient's brain above a critical ischemic threshold.