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Catheter based selective hypothermia reduces stroke volume during focal cerebral ischemia in swine
  1. Thomas K Mattingly1,
  2. Lynn M Denning1,
  3. Karen L Siroen1,
  4. Barb Lehrbass2,
  5. Pablo Lopez-Ojeda1,2,
  6. Larry Stitt3,
  7. David M Pelz1,2,
  8. Sumit Das4,
  9. Lee-Cyn Ang4,
  10. Donald H Lee1,2,
  11. Stephen P Lownie1,2
  1. 1Department of Clinical Neurological Sciences, Western University, London, Ontario, Canada
  2. 2Department of Medical Imaging, Western University, London, Ontario, Canada
  3. 3Department of Statistics, Stitt Statistical Services, Inc, London, Ontario, Canada
  4. 4Department of Pathology, Western University, London, Ontario, Canada
  1. Correspondence to Dr TK Mattingly, London Health Sciences Center, Western University, University Hospital, 339 Windermere Road, London, ON, Canada N6A 5A5; tmattingly206{at}gmail.com

Abstract

Background Total body hypothermia is an established neuroprotectant in global cerebral ischemia. The role of hypothermia in acute ischemic stroke remains uncertain. Selective application of hypothermia to a region of focal ischemia may provide similar protection with more rapid cooling and elimination of systemic side effects. We studied the effect of selective endovascular cooling in a focal stroke model in adult domestic swine.

Methods After craniotomy under general anesthesia, a proximal middle cerebral artery branch was occluded for 3 h, followed by 3 h of reperfusion. In half of the animals, selective hypothermia was induced during reperfusion using a dual lumen balloon occlusion catheter placed in the ipsilateral common carotid artery. Following reperfusion, the animals were sacrificed. Brain MRI and histology were evaluated by experts who were blinded to the intervention.

Results 25 animals were available for analysis. Using selective hypothermia, hemicranial temperature was successfully cooled to a mean of 26.5°C. Average time from start of perfusion to attainment of moderate hypothermia (<30°C) was 25 min. Mean MRI stroke volumes were significantly reduced by selective cooling (0.050±0.059 control, 0.005±0.011 hypothermia (ratio stroke:hemisphere volume) (p=0.046). Stroke pathology volumes were reduced by 42% compared with controls (p=0.256).

Conclusions Selective moderate hypothermia was rapidly induced using endovascular techniques in a clinically realistic swine stroke model. A significant reduction in stroke volume on MRI was observed. Endovascular selective hypothermia can provide neuroprotection within time frames relevant to acute ischemic stroke treatment.

  • Stroke
  • Intervention
  • Catheter

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