Ultrarapid, Convection-Enhanced Intravascular Hypothermia

Abstract

Background and Purpose-Hypothermia has been shown to be neuroprotective in a variety of clinical settings.Unfortunately, poor delivery techniques and insufficient data in appropriate preclinical models have hampered its development in human stroke. To address these limitations, we have devised a 10F intravascular catheter capable of rapid systemic cooling of nonhuman primates. Methods-Placed in the inferior vena cava via a transfemoral approach, the catheter was used to induce mild systemic hypothermia 3 hours after the onset of hemispheric stroke in baboons. Results-Cooling was achieved at a rate of 6.3Ϯ0.8°C/h. Target brain temperatures (32.2Ϯ0.2°C) were reached at the same time (47.7Ϯ6.32 minutes) as target esophageal temperatures (32.0Ϯ0.0°C). Hypothermia was maintained for 6 hours in all animals. Animals did not experience the infections, coagulopathy, or cerebral edema commonly seen with surface cooling methods in human stroke. Conclusions-These data suggest that a brief episode of mild core hypothermia instituted at a clinically relevant time point can be achieved in primate stroke and that our intravascular cooling technique provides safe, rapid, and reproducible hypothermia. (Stroke.

Induced Hypothermia for Acute Stroke

“…The new devices exchange heat via transduction through internal circulation within the catheter; no fluid enters the patient. 50 Thrombotic complications are reduced with the use of the antithromboticeluting catheter.…”

Priorities for Clinical Research in Intracerebral Hemorrhage

“…There now exist several devices in various stages of preclinical development that hold the hope of creating regional brain hypothermia without whole-body cooling. 209 Studies will need to compare the safety and efficacy of these devices in the setting of ICH. Each of these devices requires a minor surgical procedure to be performed in addition to clot evacuation or conservative management.…”

Therapeutic hypothermia in acute ischemic stroke

“…The main advantages of core cooling are shorter time to goal temperature and more precise hypothermic control. 15,26,32,39 In recent years, there has been an increased interest in selective brain cooling for the treatment of ischemic stroke. This concept has led to the invention of 2 devices for implementation.…”