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(Stroke. 1999;30:1802-1806.)
© 1999 American Heart Association, Inc.

Original Contributions

Increased Cerebral CO₂ Reactivity After Heparin-Mediated Extracorporal LDL Precipitation (HELP) in Patients With Coronary Heart Disease and Hyperlipidemia

Thomas K. Pfefferkorn, MD; Hans-Peter Knüppel; Beate R. Jaeger, MD; Joachim Thiery, MD Gerhard F. Hamann, MD

From the Department of Neurology (T.K.P., H.-P.K., G.F.H.) and Institute of Clinical Chemistry (B.R.J., J.T.), Klinikum Grosshadern, Ludwig-Maximilians-Universität, Munich, Germany.

Correspondence and reprint requests to Dr Gerhard F. Hamann, Neurologische Klinik, Klinikum Grosshadern, Ludwig-Maximilians-Universität, Marchioninistr. 15, 81377 München, Germany. E-mail hamann{at}brain.nefo.med.uni-muenchen.de

Background and Purpose—There is experimental and clinical evidence that hypercholesterolemia leads to an impairment of endothelial function in coronary and cerebral arteries. Using transcranial Doppler sonography, we examined CO₂ reactivity as a marker of cerebral vasoreactivity in patients with coronary heart disease and hyperlipidemia before and after drastic lowering of LDL cholesterol, lipoprotein(a) [Lp(a)], and fibrinogen levels by heparin-mediated extracorporal LDL precipitation (HELP).

Methods—CO₂ reactivity was determined in 13 patients with coronary artery disease and hyperlipidemia undergoing regular HELP therapy. Middle cerebral artery mean blood flow velocity (MFV) was detected by transcranial Doppler. CO₂ reactivity was calculated as the percent change of MFV during hypercapnia, induced by ventilation of carbogene (5% CO₂, 95% O₂), to normocapnia. Patients with extracranial or intracranial stenoses were excluded. Other parameters such as blood viscosity, heart rate, and blood pressure were measured to control hemorheologic and systemic influences on CO₂ reactivity.

Results—A single HELP treatment reduced total cholesterol, LDL cholesterol, Lp(a), triglycerides, and fibrinogen levels by >50% (P<0.001). Blood viscosity significantly decreased from 1.24±0.04 to 1.07±0.02 mPa (P<0.001). Blood pressure, heart rate, and MFV did not change significantly. CO₂ reactivity increased from 22% ± 21% to 36% ± 18% (P<0.05).

Conclusions—Fast and drastic removal of LDL cholesterol, Lp(a), and fibrinogen from plasma results in an improvement of cerebrovascular reactivity in patients with coronary heart disease and hyperlipidemia. The clinical use of HELP in patients with impaired cerebrovascular reactivity might be promising.

Key Words: cerebrovascular reactivity • endothelium • hypercholesterolemia • lipoproteins, LDL • ultrasonography

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