Selective Brain Cooling with Endovascular Intracarotid Infusion of Cold Saline: A Pilot Feasibility Study

Choi, Jae Hyung; Marshall, Randolph S.; Neimark, Matthew A.; Konstas, Angelos A.; Lin, E. C. C.; Chiang, Yuting; Mast, H.; Rundek, Tatjana; Mohr, J. P.; Pile‐Spellman, John

doi:10.3174/ajnr.a1961

Cited by 78 publications

(74 citation statements)

References 51 publications

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“…[19][20][21][22] However, the in vivo experiments with infusion of cold isotonic saline (4°C-17°C; 33 mL/min for 10 minutes) into the ICA could only demonstrate a temperature drop of 0.84°C within the jugular venous bulb; these experiments were performed in patients undergoing diagnostic cerebral angiography. 23 Moreover, hemodilution effects and volume overload may be other limiting factors for longer application of this technique in patients with acute stroke.…”

Section: Discussionmentioning

confidence: 99%

Combined Selective Cerebral Hypothermia and Mechanical Artery Recanalization in Acute Ischemic Stroke: In Vitro Study of Cooling Performance

Cattaneo

Schumacher

Wolfertz

et al. 2015

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE: Therapeutic hypothermia represents a promising neuroprotective treatment for patients with ischemic stroke. Selective, intracarotid blood cooling may initiate rapid and early brain hypothermia, reduce systemic effects, and allow combined endovascular mechanical thrombectomy. For this approach, a balloon cooling catheter system was designed and studied in vitro to optimize its cooling performance.

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Section: Discussionmentioning

confidence: 99%

Combined Selective Cerebral Hypothermia and Mechanical Artery Recanalization in Acute Ischemic Stroke: In Vitro Study of Cooling Performance

Cattaneo

Schumacher

Wolfertz

et al. 2015

AJNR Am J Neuroradiol

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“…The credibility [34], safety, and eicacy of LEVI in Rhesus monkeys were also conirmed, as infusion of cold-lactated Ringer's solution was used to achieve statistically signiicant degrees of peri-infarct cooling without apparent vasogenic edema or other comorbidities [35]. Additionally, the safety and feasibility of LEVI was recently veriied in humans [36]. In nine human patients with partially or completely treated cerebrovascular diseases undergoing diagnostic cerebral angiogram, 7°C LEVI at ~33 mL/min for 10-13 min was able to reduce jugular venous blood temperature (a proxy for brain temperature) by 0.84°C while reducing rectal temperature by 0.15°C and having no signiicant efects on vital signs.…”

Section: Hypothermia Via Local Endovascular Infusionmentioning

confidence: 99%

“…Considering that surface-cooling methods frequently take 3-7 h to reach target temperatures [19], it would be impossible for any stroke patient to fall within an optimal treatment window. By contrast, LEVI can establish target temperatures in a mater of minutes [36]; in a 300-g localized cerebral infarct, LEVI atained target temperatures 30 times faster than classic surface cooling and 10-20 times faster than systemic infusion of cold saline into the inferior vena cava [27]. The time saved by using LEVI translates to superior degrees of neuroprotection and an improved quality of life for ischemic stroke patients.…”

Section: Maximized Rate Of Coolingmentioning

confidence: 99%

Hypothermia in Stroke Therapy: Systemic versus Local Application

Huber¹,

Duan²,

Chandra³

et al. 2017

Hypoxia and Human Diseases

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Presently, there are no efective, widely applicable therapies for ischemic stroke. There is strong clinical evidence for the neuroprotective beneits of hypothermia, and surfacecooling methods have been utilized for decades in the treatment of cerebral ischemia during cardiac arrest, but complications with hypothermia induction have hindered its clinical acceptance in ischemic stroke therapy. Recently, the microcatheter-based local endovascular infusion (LEVI) of cold saline directly to the infarct site has been proposed as a solution to the drawbacks of surface cooling. The safety and eicacy of LEVI in rat models have been established, and implementation in larger animals has been similarly encouraging. A recent pilot study even established the safety of LEVI in humans. This review seeks to outline the major research on LEVI, discusses the mechanisms that mediate its superior neuroprotection over surface and systemic cooling, and identiies areas that warrant further investigation. While LEVI features improvements on surface cooling, its core mechanisms of neuroprotection are still largely shared with therapeutic hypothermia in general. As such, the mechanisms of hypothermia-based neuroprotection are discussed as well.

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“…23 Furthermore, a clinical pilot study showed that the feasibility, safety, and physiological responses of ICSI were satisfactory. 5 Compared with systemic cooling and an ice cap, we have found in our laboratory that there are apparent advantages associated with using ICSI for improving the outcomes of ischemic stroke. 18 Although ICSI is a promising neuroprotective technique, it is difficult to apply it clinically.…”

mentioning

confidence: 95%

Interrupted intracarotid artery cold saline infusion as an alternative method for neuroprotection after ischemic stroke

Wu²,

Zhong³

et al. 2012

FOC

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Object Intracarotid artery cold saline infusion (ICSI) is an effective method for protecting brain tissue, but its use is limited because of undesirable secondary effects, such as severe decreases in hematocrit levels, as well as its relatively brief duration. In this study, the authors describe and investigate the effects of a novel ICSI pattern (interrupted ICSI) relative to the traditional method (uninterrupted ICSI). Methods Ischemic strokes were induced in 85 male Sprague-Dawley rats by occluding the middle cerebral artery for 3 hours using an intraluminal filament. Uninterrupted infusion groups received an infusion at 15 ml/hour for 30 minutes continuously. The same infusion speed was used in the interrupted infusion groups, but the whole duration was divided into trisections, and there was a 20-minute interval without infusion between sections. Forty-eight hours after reperfusion, H & E and silver nitrate staining were utilized for morphological assessment. Infarct sizes and brain water contents were determined using H & E staining and the dry-wet weight method, respectively. Levels of neuron-specific enolase (NSE), S100β protein, and matrix metalloproteinase 9 (MMP-9) in the serum were determined using enzyme-linked immunosorbent assay. Neurological deficits were also evaluated. Results Histology showed that interrupted ICSI did not affect neurons or fibers in rat brains, which suggests that this method is safe for brain tissues with ischemia. The duration of hypothermia induced by interrupted ICSI was longer than that induced via the traditional method, and the decrease in hematocrit levels was less pronounced. There were no differences in infarct size or brain water content between uninterrupted and interrupted ICSI groups, but neuron-specific enolase and matrix metalloproteinase 9 serum levels were more reduced after interrupted ICSI than after the traditional method. Conclusions Interrupted ICSI is a safe method. Compared with traditional ICSI, the interrupted method has a longer duration of hypothermia and less effect on hematocrit and offers more potentially improved neuroprotection, thereby making it more attractive as an infusion technique in the clinic.

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Selective Brain Cooling with Endovascular Intracarotid Infusion of Cold Saline: A Pilot Feasibility Study

Cited by 78 publications

References 51 publications

Combined Selective Cerebral Hypothermia and Mechanical Artery Recanalization in Acute Ischemic Stroke: In Vitro Study of Cooling Performance

Combined Selective Cerebral Hypothermia and Mechanical Artery Recanalization in Acute Ischemic Stroke: In Vitro Study of Cooling Performance

Hypothermia in Stroke Therapy: Systemic versus Local Application

Interrupted intracarotid artery cold saline infusion as an alternative method for neuroprotection after ischemic stroke

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