Focal cooling of brain parenchyma in a transient large vessel occlusion model: proof-of-concept
Authors
Caroff, JildazKing, 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 RadiologyDocument Type
Journal ArticlePublication Date
2019-07-30Keywords
acute ischemic strokeanimal model
hypothermia
mechanical thrombectomy
Analytical, Diagnostic and Therapeutic Techniques and Equipment
Cardiovascular Diseases
Nervous System
Nervous System Diseases
Neurology
Radiology
Surgery
Metadata
Show full item recordAbstract
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-2019-015179Permanent Link to this Item
http://hdl.handle.net/20.500.14038/48377PubMed ID
31363042Related Resources
ae974a485f413a2113503eed53cd6c53
10.1136/neurintsurg-2019-015179