Thomas K Mattingly1, Lynn M Denning1, Karen L Siroen1, Barb Lehrbass2, Pablo Lopez-Ojeda3, Larry Stitt4, David M Pelz3, Sumit Das5, Lee-Cyn Ang5, Donald H Lee3, Stephen P Lownie3. 1. Department of Clinical Neurological Sciences, Western University, London, Ontario, Canada. 2. Department of Medical Imaging, Western University, London, Ontario, Canada. 3. Department of Clinical Neurological Sciences, Western University, London, Ontario, Canada Department of Medical Imaging, Western University, London, Ontario, Canada. 4. Department of Statistics, Stitt Statistical Services, Inc, London, Ontario, Canada. 5. Department of Pathology, Western University, London, Ontario, Canada.
Abstract
BACKGROUND: Total body hypothermia is an established neuroprotectant in global cerebral ischemia. The role of hypothermia in acute ischemic stroke remains uncertain. Selective application of hypothermia to a region of focal ischemia may provide similar protection with more rapid cooling and elimination of systemic side effects. We studied the effect of selective endovascular cooling in a focal stroke model in adult domestic swine. METHODS: After craniotomy under general anesthesia, a proximal middle cerebral artery branch was occluded for 3 h, followed by 3 h of reperfusion. In half of the animals, selective hypothermia was induced during reperfusion using a dual lumen balloon occlusion catheter placed in the ipsilateral common carotid artery. Following reperfusion, the animals were sacrificed. Brain MRI and histology were evaluated by experts who were blinded to the intervention. RESULTS: 25 animals were available for analysis. Using selective hypothermia, hemicranial temperature was successfully cooled to a mean of 26.5 °C. Average time from start of perfusion to attainment of moderate hypothermia (<30 °C) was 25 min. Mean MRI stroke volumes were significantly reduced by selective cooling (0.050±0.059 control, 0.005±0.011 hypothermia (ratio stroke:hemisphere volume) (p=0.046). Stroke pathology volumes were reduced by 42% compared with controls (p=0.256). CONCLUSIONS: Selective moderate hypothermia was rapidly induced using endovascular techniques in a clinically realistic swine stroke model. A significant reduction in stroke volume on MRI was observed. Endovascular selective hypothermia can provide neuroprotection within time frames relevant to acute ischemic stroke treatment. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/
BACKGROUND: Total body hypothermia is an established neuroprotectant in global cerebral ischemia. The role of hypothermia in acute ischemic stroke remains uncertain. Selective application of hypothermia to a region of focal ischemia may provide similar protection with more rapid cooling and elimination of systemic side effects. We studied the effect of selective endovascular cooling in a focal stroke model in adult domestic swine. METHODS: After craniotomy under general anesthesia, a proximal middle cerebral artery branch was occluded for 3 h, followed by 3 h of reperfusion. In half of the animals, selective hypothermia was induced during reperfusion using a dual lumen balloon occlusion catheter placed in the ipsilateral common carotid artery. Following reperfusion, the animals were sacrificed. Brain MRI and histology were evaluated by experts who were blinded to the intervention. RESULTS: 25 animals were available for analysis. Using selective hypothermia, hemicranial temperature was successfully cooled to a mean of 26.5 °C. Average time from start of perfusion to attainment of moderate hypothermia (<30 °C) was 25 min. Mean MRI stroke volumes were significantly reduced by selective cooling (0.050±0.059 control, 0.005±0.011 hypothermia (ratio stroke:hemisphere volume) (p=0.046). Stroke pathology volumes were reduced by 42% compared with controls (p=0.256). CONCLUSIONS: Selective moderate hypothermia was rapidly induced using endovascular techniques in a clinically realistic swinestroke model. A significant reduction in stroke volume on MRI was observed. Endovascular selective hypothermia can provide neuroprotection within time frames relevant to acute ischemic stroke treatment. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/
Authors: Andrea M Herrmann; Stephan Meckel; Matthew J Gounis; Leona Kringe; Edith Motschall; Christoph Mülling; Johannes Boltze Journal: J Cereb Blood Flow Metab Date: 2019-02-07 Impact factor: 6.200
Authors: Patrick Lyden; Sara Weymer; Chris Coffey; Merit Cudkowicz; Samantha Berg; Sarah O'Brien; Marc Fisher; E Clarke Haley; Pooja Khatri; Jeff Saver; Steven Levine; Howard Levy; Marilyn Rymer; Lawrence Wechsler; Ashutosh Jadhav; Elizabeth McNeil; Salina Waddy; Kent Pryor Journal: Stroke Date: 2016-11-01 Impact factor: 7.914