<p><strong>Background.</strong> Ischaemic stroke is one of the leading causes of death and disability worldwide. Selective intracarotid cerebral hypothermia is one of the promising methods to prevent ischaemic stroke. However, currently available studies do not allow us to conclude the effectiveness of applying this method in humans and assess its effect on the system temperature.</p><p><strong>Aim.</strong> To investigate the effect of selective intracarotid cerebral hypothermia on the size of ischaemic stroke in large pigs, determining the optimal period of hypothermia and the severity of the effects of intracarotid hypothermia on the system temperature.</p><p><strong>Methods.</strong> The study was conducted on mini-pigs weighing 30–70 kg and included two stages. During the first stage, pigs were divided into two groups: control (n = 4) and intracarotid hypothermia for 3 h, exciting periods before and after reperfusion (n = 2). During the second stage, animals were also divided into two groups: hypothermia group within 1.5 h before reperfusion (n = 2) and hypothermia group within 1.5 h after reperfusion (n = 2). The technique for modelling ischaemic stroke was the same as in all groups and consisted of frontotemporal craniotomy and compression of the middle cerebral artery for 3 h. Intracarotid hypothermia was performed by infusing + 4 °C NaCl solution in the ascending pharyngeal artery. At 48 h after starting the experiment, a brain magnetic resonance imaging scan was performed to determine the size of the stroke.</p><p><strong>Results.</strong> The mean size of the stroke focusing in the control group was 10.75%, in the hypothermia group before reperfusion (10.95%) and in the hypothermia group after reperfusion (1.65%) of the volume of the cerebral hemisphere. The stroke size in the hypothermia group for 3 h could not be determined due to complications that developed in animals intraoperatively and postoperatively. The effect of intracarotid hypothermia on the systemic temperature in an animal weighing 65 kg was 0.4 °C.</p><p><strong>Conclusion.</strong> Based on the study results, a marked decrease in the focus of ischaemic stroke was found with the use of intracarotid hypothermia within 1.5 h after reperfusion. Intracarotid hypothermia was found to do not have a pronounced effect on the system temperature.</p><p>Received 2 May 2020. Revised 20 May 2020. Accepted 25 May 2020.</p><p><strong>Funding:</strong> The work is supported by a grant of the Russian Foundation for Basic Research (project No. 18-415-540025).</p><p><strong>Conflict of interest:</strong> Authors declare no conflict of interest.</p><p><strong>Author contributions</strong><br />Conception and study design: E.I. Fartakov, V.V. Lomivorotov, E.I. Kretov, A.R. Tarkova<br />Data collection and analysis: D.U. Malaev, A.A. Boykov, A.A. Prokhorikhin, D.V. Volchenko, I.S. Zykov, P.O. Seleznev<br />Drafting the article: E.I. Fartakov, D.U. Malaev, A.R. Tarkova<br />Critical revision of the article: E.I. Kretov, V.V. Lomivorotov, V.I. Baystrukov, N.I. Grachev, D.S. Sergeevichev, A.M. Chernyavskiy<br />Final approval of the version to be published: E.I. Fartakov, V.V. Lomivorotov, D.U. Malaev, A.R. Tarkova, A.A. Boykov, <br />A.A. Prokhorikhin, D.V. Volchenko, I.S. Zykov, P.O. Seleznev, V.I. Baystrukov, N.I. Grachev, D.S. Sergeevichev, A.M. Chernyavskiy, E.I. Kretov</p>

Highlights. Mechanical thrombectomy is the “gold standard” treatment of patients with large-vessel occlusions. Five randomized trials conducted in 2015 made a significant contribution to the development and introduction of mechanical thrombectomy into clinical practice. The DAWN and DEFUSE-3 trials have provided new insights into the pathophysiology of ischemic stroke and ensured the advancement in the therapeutic field.Abstract. Stroke is one of the leading causes of death and disability worldwide. The general strategy for the treatment of ischemic stroke is aimed at restoring blood flow to the ischemic regions of the brain. Intravenous thrombolysis has been the treatment for acute ischemic stroke since 1996. However, since 2015, as a result of 5 randomized trials, endovascular mechanical thrombectomy has become the gold standard for the treatment of patients with large cerebral artery occlusion. The DAWN and DEFUSE 3 trials have provided new insights into the pathophysiology of ischemic stroke, shifting the paradigm from “time = brain” to “collaterals = brain”. In this article, the authors will consider development of endovascular devices, modern mechanical thrombectomy techniques, and directions for further research of endovascular treatment for ischemic stroke.

The paper presents a clinical case of endovascular treatment for a patient affected by acute myocardial infarction combined with acute ischemic stroke. The study emphasizes a role of early diagnosis of ischemic stroke in timely detection of cerebral embolism in large vessels during the postoperative period. Treatment strategy is analyzed along with the effectiveness of intravascular thrombectomy that significantly reduces mortality and disability of patients with acute cerebrovascular disease.