Intra Arterial Heparin Flushing Increases Cereberal Blood Flow in Chronic Ischemic Stroke Patients

Abstract

BACKGROUND: Recently, stroke therapy is focused on reperfusion therapies for restoring cerebral blood flow (CBF) and minimizing the undesired effects of neuron ischemia. However, the thrombolytic therapy to restore CBF was restricted with narrow time window. On other hands, not many patients can reach the treatment immediately after the onset of stroke. A wider time window therapy that might increase CBF would probably helpful. This study aims to investigate the CBF improvement after intra arterial heparin flushing (IAHF) therapy in chronic stroke patients.METHODS: A clinical trial was conducted with time sampling. We collected chronic ischemic stroke subjects (with stroke onset ≥30 days) within periods February-September 2015. We investigated CBF before and after IAHF treatment in 75 chronic stroke patients. The difference before and after IAHF treatment in subgroup which is classified with infarct size and lesion area was tested. CBF was measured using MRI Quality Arterial Spin Labeling (qASL) with region of interest around infarct lesion.RESULTS: We found a significant CBF improvement (p<0.001) around infarct area after IAHF treatment with average 10.39mL/100g/min raised. CBF improvement was found in lacunar infarct (p<0.001) and non lacunar (p<0.001), also in infarct in cortical (p<0.05), subcortical (p<0.001) and both area (p<0.05).CONCLUSION: IAHF is associated with increased CBF around infarct area and IAHF probably offers some benefit for chronic stroke.KEYWORDS: IAHF, CBF, chronic stroke, ischemic, lacunar, non lacunar, cortical lesion, subcortical lesion

Renal intra-arterial heparin flushing for blood pressure control in refractory hypertension: A new method to salvage the unsalvageable renal artery stenosis

“…also performed DSA procedures with an intra-arterial heparin bolus in 75 ischemic stroke patients with an onset of more than 30 days that resulted in an increase in blood flow at the cerebral infarction area ( P < 0.001) with an increase in average flow. [6]…”

“…Therefore, IAHF was preferred. The method was done by diluting 5000 IU heparin with 500 cc normal saline otsu (Otsuka, Lawang, Indonesia) to make the flushing solution;[6] afterwards, the solution was flushed into the ostium of both renal artery.…”

Revisiting the grammar of Tau aggregation and pathology formation: how new insights from brain pathology are shaping how we study and target Tauopathies

“…21,335 Other concerns for the downstream applications in vitro, in cells and in vivo arise when using added heparin as a cofactor to fibrillize Tau. These may include interference with the Tau fibril-targeting compounds, 343 disruption of the cellular uptake of Tau fibrils, 344 and causing vasodilation or immune response in animals, 345,346 all of which may contribute to the modification of Tau seeding propensity non-contingent on the inherent properties of the Tau seed itself.…”

“…The tight binding of heparin or other cofactors to Tau fibrils has significant implications for using heparin-induced fibrils to investigate Tau fibril toxicity mechanisms of seeding activity in cells or in vivo as the Tau-non-contingent responses, due to the presence or release of these molecules may occur. In the case of heparin, this includes vasodilation of the blood vessels 346 and immune 345 or aberrant cell stress responses. [395][396][397][398][399][400] Also, the presence of heparin of other cofactors might directly impact the post-translational modifications of Tau fibrils, 401 alter their surface properties, secondary nucleation events, and thus their seeding activity and spreading through extracellular matrix interactions.…”

Case Series: Chronic Pediatric Ischemic Stroke in Childs Successfully Treated with IAHF Procedure

“…Based on previous study in adult, IAHF procedure can significantly improve CBF for chronic stroke in adult. It can recanalization vessel that led to reperfusion of left carotid arteries and vertebral arteries [14]. After completing the flushing process, femoral artery bleeding was stopped with vascular closure device.…”