Title

Focal cooling of brain parenchyma in a transient large vessel occlusion model: proof-of-concept

UMMS Affiliation

New England Center for Stroke Research, Department of Radiology

Publication Date

2019-07-30

Document Type

Article

Disciplines

Analytical, Diagnostic and Therapeutic Techniques and Equipment | Cardiovascular Diseases | Nervous System | Nervous System Diseases | Neurology | Radiology | Surgery

Abstract

INTRODUCTION: The neuroprotective benefit of therapeutic hypothermia (TH) has been demonstrated, but systemic side effects and time required to achieve effective TH in acute ischemic stroke (AIS) care limits clinical use. We investigate rapid and localized cooling using a novel insulated catheter in an ischemia-reperfusion model.

METHODS: In phase I (n=4), cold saline was delivered to the canine internal carotid artery via an insulated catheter. Temperature was measured using intracerebral thermocouples. The coolant flow rate was varied to meet a target temperature of 31-32 degrees C in the hemisphere infused. In phase II (n=8), a temporary middle cerebral artery occlusion was created. Five dogs underwent localized TH at the optimal flow rate from phase I, and the remaining animals were untreated controls. Cooling was initiated 5 min before recanalization and continued for an additional 20 min following 45 min of occlusion duration. The outcome was infarct volume and neurological function.

RESULTS: Ipsilateral tissue cooling rates were 2.2+/-2.5 degrees C/min at a flow rate of 20-40 mL/min with an observed minimum of 23.8 degrees C. Tissue cooling was localized to the ipsilateral side of the infusion with little impact on temperatures of the core or contralateral hemisphere of the brain. In phase II, animals tolerated TH with minimal systemic impact. Infarct volume in treated animals was 0.2+/-0.2 cm(3), which was smaller than in sham animals (3.8+/-1.0 cm(3)) as well as six untreated historical control animals (4.0+/-2.8 cm(3)) (p=0.013).

CONCLUSIONS: Proof-of-concept data show that localised brain TH can be quickly and safely achieved through a novel insulated catheter. The small infarct volumes suggest potential benefit for this approach.

Keywords

acute ischemic stroke, animal model, hypothermia, mechanical thrombectomy

DOI of Published Version

10.1136/neurintsurg-2019-015179

Source

J Neurointerv Surg. 2019 Jul 30. pii: neurintsurg-2019-015179. doi: 10.1136/neurintsurg-2019-015179. [Epub ahead of print] Link to article on publisher's site

Journal/Book/Conference Title

Journal of neurointerventional surgery

Related Resources

Link to Article in PubMed

PubMed ID

31363042

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