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

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    Authors
    Caroff, Jildaz
    King, Robert M.
    Mitchell, Jennifer E.
    Marosfoi, Miklos G.
    Licwinko, Joseph R.
    Gray-Edwards, Heather L.
    Puri, Ajit S.
    Merrill, Thomas L.
    Gounis, Matthew J.
    UMass Chan Affiliations
    New England Center for Stroke Research, Department of Radiology
    Document Type
    Journal Article
    Publication Date
    2019-07-30
    Keywords
    acute ischemic stroke
    animal model
    hypothermia
    mechanical thrombectomy
    Analytical, Diagnostic and Therapeutic Techniques and Equipment
    Cardiovascular Diseases
    Nervous System
    Nervous System Diseases
    Neurology
    Radiology
    Surgery
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    Link to Full Text
    https://doi.org/10.1136/neurintsurg-2019-015179
    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.
    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

    DOI
    10.1136/neurintsurg-2019-015179
    Permanent Link to this Item
    http://hdl.handle.net/20.500.14038/48377
    PubMed ID
    31363042
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    Link to Article in PubMed

    ae974a485f413a2113503eed53cd6c53
    10.1136/neurintsurg-2019-015179
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