Selective intra-carotid blood cooling in acute ischemic stroke: A safety and feasibility study in an ovine stroke model

• Published in: Journal of cerebral blood flow and metabolism Vol. 41; no. 11; pp. 3097 - 3110
• Main Authors: Cattaneo, Giorgio FM, Herrmann, Andrea M, Eiden, Sebastian A, Wieser, Manuela, Kellner, Elias, Doostkam, Soroush, Süß, Patrick, Kiefer, Selina, Fauth, Lisa, Maurer, Christoph J, Wolfertz, Julia, Nitzsche, Björn, Büchert, Michael, Jost, Tobias, Ihorst, Gabriele, Haberstroh, Jörg, Mülling, Christoph, Strecker, Christoph, Niesen, Wolf-Dirk, Shah, Mukesch J, Urbach, Horst, Boltze, Johannes, Meckel, Stephan
• Format: Journal Article
• Language: English
• Published: London, England SAGE Publications 01.11.2021
• Subjects: Angiography, Digital Subtraction - methods; Animals; Carotid Artery, Common - diagnostic imaging; Carotid Artery, Common - pathology; Carotid Artery, Common - surgery; Catheterization - methods; Cold Temperature - adverse effects; Disease Models, Animal; Endovascular Procedures - methods; Feasibility Studies; Hypothermia, Induced - adverse effects; Hypothermia, Induced - instrumentation; Infarction, Middle Cerebral Artery - diagnostic imaging; Infarction, Middle Cerebral Artery - pathology; Infarction, Middle Cerebral Artery - therapy; Ischemic Stroke - therapy; Ischemic Stroke - veterinary; Neuroprotective Agents - pharmacology; Original; Outcome Assessment, Health Care; Perfusion Imaging - methods; Safety; Sheep; Thrombectomy - methods; endovascular stroke therapy; catheter; Acute ischemic stroke; hypothermia; selective brain cooling
• ISSN: 0271-678X; 1559-7016; 1559-7016
• DOI: 10.1177/0271678X211024952

Selective therapeutic hypothermia (TH) showed promising preclinical results as a neuroprotective strategy in acute ischemic stroke. We aimed to assess safety and feasibility of an intracarotid cooling catheter conceived for fast and selective brain cooling during endovascular thrombectomy in an ovine stroke model. Transient middle cerebral artery occlusion (MCAO, 3 h) was performed in 20 sheep. In the hypothermia group (n = 10), selective TH was initiated 20 minutes before recanalization, and was maintained for another 3 h. In the normothermia control group (n = 10), a standard 8 French catheter was used instead. Primary endpoints were intranasal cooling performance (feasibility) plus vessel patency assessed by digital subtraction angiography and carotid artery wall integrity (histopathology, both safety). Secondary endpoints were neurological outcome and infarct volumes. Computed tomography perfusion demonstrated MCA territory hypoperfusion during MCAO in both groups. Intranasal temperature decreased by 1.1 °C/3.1 °C after 10/60 minutes in the TH group and 0.3 °C/0.4 °C in the normothermia group (p < 0.001). Carotid artery and branching vessel patency as well as carotid wall integrity was indifferent between groups. Infarct volumes (p = 0.74) and neurological outcome (p = 0.82) were similar in both groups. Selective TH was feasible and safe. However, a larger number of subjects might be required to demonstrate efficacy.