External counterpulsation for acute ischaemic stroke

Some studies have indicated that poor cerebral perfusion is related to unfavourable functional outcomes, precipitating strokes and other vascular events, which are often responsible for high mortality rates. External counterpulsation (ECP) is a non-invasive and acceptable method which is known to improve perfusion of the brain. It provides pressure to the calves, thighs and buttocks by means of air-filled cuffs. This helps to increase blood flow to the heart, brain and kidneys. This review identified two randomised controlled trials (RCTs) of ECP involving 160 participants with acute ischaemic stroke. There is no convincing evidence to support the routine use of ECP for the treatment of patients with acute ischaemic stroke. Further high-quality and large-scale RCTs are needed.

Authors' conclusions: 

The methodological quality of the included studies was poor, and reliable conclusions could not be drawn from the present data. High-quality and large-scale RCTs are needed.

Read the full abstract...

External counterpulsation (ECP) may improve cerebral blood flow, and it has been proposed as a potential therapy for patients with ischaemic stroke.


To assess the efficacy and safety of ECP for acute ischaemic stroke.

Search strategy: 

We searched the Cochrane Stroke Group Trials Register (June 2011), Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, 2011 Issue 2), MEDLINE (1948 to June 2011), EMBASE (1980 to June 2011), CINAHL (1982 to June 2011), AMED (Allied and Complementary Medicine) (1985 to June 2011), China Biological Medicine Database (CBM) (1978 to June 2011), Chinese National Knowledge Infrastructure (CNKI) (1979 to June 2011), Chinese Science and Technique Journals Database (VIP) (1989 to June 2011) and Wanfang Data (1984 to June 2011). We also searched ongoing trials registers, reference lists and relevant conference proceedings and contacted authors and manufacturers of external counterpulsation devices.

Selection criteria: 

Randomised controlled trials (RCTs) in which ECP (started within seven days of stroke onset) was compared with sham treatment or no treatment, or ECP plus routine treatment was compared with routine treatment alone, in patients with acute ischaemic stroke.

Data collection and analysis: 

Two review authors independently assessed trial quality and extracted data, checked for adverse events data and contacted trialists for missing information.

Main results: 

We included two trials involving 160 patients. Numbers of death or dependent patients at the end of at least three months follow-up were not reported in either of the included trials. The outcome measure used in the included trials was only the number of participants with improvement of neurological impairment after treatment according to the Modified Edinburgh-Scandinavian Stroke Scale (MESSS) or self-making criteria. ECP was associated with a significant increase in the number of participants whose neurological impairment improved (risk ratio (RR) 1.75, 95% confidence interval (CI) 1.37 to 2.23). Only one trial reported no adverse events.