Cold blood perfusion for selective hypothermia in acute ischemic stroke

Abstract

Hypothermia is the most reliably effective neuroprotectant, and yet systemic complications limit application. A large body of animal data suggests that hypothermia is effective for focal cerebral ischemia, namely acute ischemic stroke. In order to apply hypothermia effectively, a selective approach is required to maximize the effect on the brain while minimizing systemic side effects. Due to poor transferability of promising findings in rodent models to human clinical trials for neuroprotection, the focus of this review is large animal gyrencephalic models. Unlike rodent data which favor mild hypothermia, the majority of large animal studies on selective hypothermia support moderate-to-deep hypothermia (<30°C). Cold blood perfusion produces the rapid rate of temperature reduction and depth of hypothermia required to produce meaningful neuroprotection. Further studies of selective hypothermia in acute ischemic stroke require attention to duration and rate of cooling to optimize the neuroprotection offered by this technique.

Multiphase adjuvant neuroprotection: A novel paradigm for improving acute ischemic stroke outcomes

“…Finally, intra-arterial selective cooling, a promising nonpharmacological treatment, can easily be performed shortly after thrombectomy to induce partial hypothermia in the ischemic area. [86][87][88][89] In previous pilot study, intra-arterial selective cooling has been performed in AIS undergoing EVT. [90] Cold 0.9% sodium chloride (4°C) was infused to the ischemic territory before recanalization (10 ml/min for 5 min) through microcatheter and postrevascularization (30 ml/min for 10 min) through the guiding catheter.…”

Neuroprotection in Acute Ischemic Stroke: A Brief Review

“…31 Contemporary studies using specialized catheters have shown the potential for rapid brain cooling. [32][33][34] A mean brain temperature of 26.5°C was achieved in 30 min in a swine acute stroke model with reduction of MRI stroke volumes compared to controls. 34 A study in a canine stroke model showed that brain cooling to 31°C could be achieved in less than 25 min, again with a significant reduction in MRI stroke volumes.…”

Cellular and Molecular Targets for Non-Invasive, Non-Pharmacological Therapeutic/Rehabilitative Interventions in Acute Ischemic Stroke

“…A preliminary specification is necessary. Regarding the therapeutical approach in acute ischemic stroke, there are two main methodological types of cooling/hypothermia interventions: (systemic) hypothermia and local (brain) cooling [93].…”