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<meta name="DC.Language" content="en" />
<meta name="DC.Title" content="Selective Brain Cooling with Endovascular Intracarotid Infusion of Cold Saline: A Pilot Feasibility Study" />
<meta name="DC.Identifier" content="10.3174/ajnr.A1961" />
<meta name="DC.Date" content="2010-05-01" />
<meta name="DC.Publisher" content="American Journal of Neuroradiology" />
<meta name="DC.Rights" content="Copyright © American Society of Neuroradiology. 
Indicates open access to non-subscribers at www.ajnr.org" />
<meta name="DC.AccessRights" content="open-access" />
<meta name="DC.Description" content="BACKGROUND AND PURPOSE: Endovascular brain cooling as a method for rapid and selective induction of hypothermic neuroprotection has not been systematically studied in humans. In this clinical pilot study we investigated the feasibility, safety, and physiologic responses of short-term brain cooling with IC-CSI.

MATERIALS AND METHODS: We studied 18 patients (50 ± 10 years old, 9 women) undergoing follow-up cerebral angiography after previous treatment of vascular malformations. Isotonic saline (4–17°C) was infused into 1 internal carotid artery at 33 mL/min for 10 minutes. Brain (JVB) and bladder/esophageal temperature measurements ( n = 9) were performed. Both MCAs were monitored with transcranial Doppler sonography ( n = 13). Arterial and JV blood were sampled to estimate hemodilution and brain oxygen extraction.

RESULTS: JVB temperature dropped ∼0.84 ± 0.13°C and systemic temperature by 0.15 ± 0.08°C from baseline (JVB versus systemic temperature: P = .0006). Systolic MCA-flow velocities decreased from 101 ± 27 to 73 ± 18 cm/s on the infused side and from 83 ± 24 to 78 ± 21 cm/s on the contralateral side (relative changes, −26 ± 8% versus −4 ± 27%; P = .009). Changes in hematocrit (−1.2 ± 1.1%) and cerebral arteriovenous oxygen difference (0.2 ± 1.0 mL O2/100 mL) were not significant. Doppler data showed no signs of vascular spasm or microemboli. No focal neurologic deficits occurred. Pain was not reported.

CONCLUSIONS: The results of this pilot study suggest that brain cooling can be achieved safely, rapidly, and selectively by means of IC-CSI, opening a new potential avenue for acute neuroprotection. Clinical investigations with control of infusion parameters and measurements of CBF, oxygen consumption, and brain temperature are warranted.

ABC
:   automated blood count
AComA
:   anterior communicating artery
AVM
:   arteriovenous malformation
BA
:   basilar artery
BMR
:   basal metabolic rate
CBF
:   cerebral blood flow
ΔA-V
:   difference between arterial and venous oxygen content
FV
:   flow velocity
IA
:   intra-arterial
ICA
:   internal carotid artery
IC-CSI
:   intracarotid cold saline infusion
JV
:   jugular vein
JVB
:   jugular venous bulb
JVBT
:   jugular venous bulb temperature
MCA
:   middle cerebral artery
MES
:   microemboli signals
N/A
:   not available
O2-Sat
:   oxygen saturation
PI
:   pulsatility index
PICA
:   posterior inferior cerebral artery
TCD
:   transcranial Doppler" />
<meta name="DC.Contributor" content="J.H. Choi" />
<meta name="DC.Contributor" content="R.S. Marshall" />
<meta name="DC.Contributor" content="M.A. Neimark" />
<meta name="DC.Contributor" content="A.A. Konstas" />
<meta name="DC.Contributor" content="E. Lin" />
<meta name="DC.Contributor" content="Y.T. Chiang" />
<meta name="DC.Contributor" content="H. Mast" />
<meta name="DC.Contributor" content="T. Rundek" />
<meta name="DC.Contributor" content="J.P. Mohr" />
<meta name="DC.Contributor" content="J. Pile-Spellman" />
<meta name="article:published_time" content="2010-05-01" />
<meta name="article:section" content="Interventional" />
<meta name="citation_title" content="Selective Brain Cooling with Endovascular Intracarotid Infusion of Cold Saline: A Pilot Feasibility Study" />
<meta name="citation_abstract" lang="en" content="&lt;h3&gt;BACKGROUND AND PURPOSE:&lt;/h3&gt;
&lt;p&gt;Endovascular brain cooling as a method for rapid and selective induction of hypothermic neuroprotection has not been systematically studied in humans. In this clinical pilot study we investigated the feasibility, safety, and physiologic responses of short-term brain cooling with IC-CSI.&lt;/p&gt;&lt;h3&gt;MATERIALS AND METHODS:&lt;/h3&gt;
&lt;p&gt;We studied 18 patients (50 ± 10 years old, 9 women) undergoing follow-up cerebral angiography after previous treatment of vascular malformations. Isotonic saline (4–17°C) was infused into 1 internal carotid artery at 33 mL/min for 10 minutes. Brain (JVB) and bladder/esophageal temperature measurements (&lt;i&gt;n&lt;/i&gt; = 9) were performed. Both MCAs were monitored with transcranial Doppler sonography (&lt;i&gt;n&lt;/i&gt; = 13). Arterial and JV blood were sampled to estimate hemodilution and brain oxygen extraction.&lt;/p&gt;&lt;h3&gt;RESULTS:&lt;/h3&gt;
&lt;p&gt;JVB temperature dropped ∼0.84 ± 0.13°C and systemic temperature by 0.15 ± 0.08°C from baseline (JVB versus systemic temperature: &lt;i&gt;P&lt;/i&gt; = .0006). Systolic MCA-flow velocities decreased from 101 ± 27 to 73 ± 18 cm/s on the infused side and from 83 ± 24 to 78 ± 21 cm/s on the contralateral side (relative changes, −26 ± 8% versus −4 ± 27%; &lt;i&gt;P&lt;/i&gt; = .009). Changes in hematocrit (−1.2 ± 1.1%) and cerebral arteriovenous oxygen difference (0.2 ± 1.0 mL O&lt;sub&gt;2&lt;/sub&gt;/100 mL) were not significant. Doppler data showed no signs of vascular spasm or microemboli. No focal neurologic deficits occurred. Pain was not reported.&lt;/p&gt;&lt;h3&gt;CONCLUSIONS:&lt;/h3&gt;
&lt;p&gt;The results of this pilot study suggest that brain cooling can be achieved safely, rapidly, and selectively by means of IC-CSI, opening a new potential avenue for acute neuroprotection. Clinical investigations with control of infusion parameters and measurements of CBF, oxygen consumption, and brain temperature are warranted.&lt;/p&gt;" />
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<meta name="twitter:title" content="Selective Brain Cooling with Endovascular Intracarotid Infusion of Cold Saline: A Pilot Feasibility Study" />
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<meta name="twitter:description" content="BACKGROUND AND PURPOSE: Endovascular brain cooling as a method for rapid and selective induction of hypothermic neuroprotection has not been systematically studied in humans. In this clinical pilot study we investigated the feasibility, safety, and physiologic responses of short-term brain cooling with IC-CSI.

MATERIALS AND METHODS: We studied 18 patients (50 ± 10 years old, 9 women) undergoing follow-up cerebral angiography after previous treatment of vascular malformations. Isotonic saline (4–17°C) was infused into 1 internal carotid artery at 33 mL/min for 10 minutes. Brain (JVB) and bladder/esophageal temperature measurements ( n = 9) were performed. Both MCAs were monitored with transcranial Doppler sonography ( n = 13). Arterial and JV blood were sampled to estimate hemodilution and brain oxygen extraction.

RESULTS: JVB temperature dropped ∼0.84 ± 0.13°C and systemic temperature by 0.15 ± 0.08°C from baseline (JVB versus systemic temperature: P = .0006). Systolic MCA-flow velocities decreased from 101 ± 27 to 73 ± 18 cm/s on the infused side and from 83 ± 24 to 78 ± 21 cm/s on the contralateral side (relative changes, −26 ± 8% versus −4 ± 27%; P = .009). Changes in hematocrit (−1.2 ± 1.1%) and cerebral arteriovenous oxygen difference (0.2 ± 1.0 mL O2/100 mL) were not significant. Doppler data showed no signs of vascular spasm or microemboli. No focal neurologic deficits occurred. Pain was not reported.

CONCLUSIONS: The results of this pilot study suggest that brain cooling can be achieved safely, rapidly, and selectively by means of IC-CSI, opening a new potential avenue for acute neuroprotection. Clinical investigations with control of infusion parameters and measurements of CBF, oxygen consumption, and brain temperature are warranted.

ABC
:   automated blood count
AComA
:   anterior communicating artery
AVM
:   arteriovenous malformation
BA
:   basilar artery
BMR
:   basal metabolic rate
CBF
:   cerebral blood flow
ΔA-V
:   difference between arterial and venous oxygen content
FV
:   flow velocity
IA
:   intra-arterial
ICA
:   internal carotid artery
IC-CSI
:   intracarotid cold saline infusion
JV
:   jugular vein
JVB
:   jugular venous bulb
JVBT
:   jugular venous bulb temperature
MCA
:   middle cerebral artery
MES
:   microemboli signals
N/A
:   not available
O2-Sat
:   oxygen saturation
PI
:   pulsatility index
PICA
:   posterior inferior cerebral artery
TCD
:   transcranial Doppler" />
<meta name="og-title" property="og:title" content="Selective Brain Cooling with Endovascular Intracarotid Infusion of Cold Saline: A Pilot Feasibility Study" />
<meta name="og-url" property="og:url" content="http://ajnr-stage2.stage.highwire.org/content/31/5/928" />
<meta name="og-site-name" property="og:site_name" content="American Journal of Neuroradiology" />
<meta name="og-description" property="og:description" content="BACKGROUND AND PURPOSE: Endovascular brain cooling as a method for rapid and selective induction of hypothermic neuroprotection has not been systematically studied in humans. In this clinical pilot study we investigated the feasibility, safety, and physiologic responses of short-term brain cooling with IC-CSI.

MATERIALS AND METHODS: We studied 18 patients (50 ± 10 years old, 9 women) undergoing follow-up cerebral angiography after previous treatment of vascular malformations. Isotonic saline (4–17°C) was infused into 1 internal carotid artery at 33 mL/min for 10 minutes. Brain (JVB) and bladder/esophageal temperature measurements ( n = 9) were performed. Both MCAs were monitored with transcranial Doppler sonography ( n = 13). Arterial and JV blood were sampled to estimate hemodilution and brain oxygen extraction.

RESULTS: JVB temperature dropped ∼0.84 ± 0.13°C and systemic temperature by 0.15 ± 0.08°C from baseline (JVB versus systemic temperature: P = .0006). Systolic MCA-flow velocities decreased from 101 ± 27 to 73 ± 18 cm/s on the infused side and from 83 ± 24 to 78 ± 21 cm/s on the contralateral side (relative changes, −26 ± 8% versus −4 ± 27%; P = .009). Changes in hematocrit (−1.2 ± 1.1%) and cerebral arteriovenous oxygen difference (0.2 ± 1.0 mL O2/100 mL) were not significant. Doppler data showed no signs of vascular spasm or microemboli. No focal neurologic deficits occurred. Pain was not reported.

CONCLUSIONS: The results of this pilot study suggest that brain cooling can be achieved safely, rapidly, and selectively by means of IC-CSI, opening a new potential avenue for acute neuroprotection. Clinical investigations with control of infusion parameters and measurements of CBF, oxygen consumption, and brain temperature are warranted.

ABC
:   automated blood count
AComA
:   anterior communicating artery
AVM
:   arteriovenous malformation
BA
:   basilar artery
BMR
:   basal metabolic rate
CBF
:   cerebral blood flow
ΔA-V
:   difference between arterial and venous oxygen content
FV
:   flow velocity
IA
:   intra-arterial
ICA
:   internal carotid artery
IC-CSI
:   intracarotid cold saline infusion
JV
:   jugular vein
JVB
:   jugular venous bulb
JVBT
:   jugular venous bulb temperature
MCA
:   middle cerebral artery
MES
:   microemboli signals
N/A
:   not available
O2-Sat
:   oxygen saturation
PI
:   pulsatility index
PICA
:   posterior inferior cerebral artery
TCD
:   transcranial Doppler" />
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      <h1 class="highwire-cite-title" id="page-title">Selective Brain Cooling with Endovascular Intracarotid Infusion of Cold Saline: A Pilot Feasibility Study</h1>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0">J.H. Choi</span>, <span class="highwire-citation-author" data-delta="1">R.S. Marshall</span>, <span class="highwire-citation-author" data-delta="2">M.A. Neimark</span>, <span class="highwire-citation-author" data-delta="3">A.A. Konstas</span>, <span class="highwire-citation-author" data-delta="4">E. Lin</span>, <span class="highwire-citation-author" data-delta="5">Y.T. Chiang</span>, <span class="highwire-citation-author" data-delta="6">H. Mast</span>, <span class="highwire-citation-author" data-delta="7">T. Rundek</span>, <span class="highwire-citation-author" data-delta="8">J.P. Mohr</span> and <span class="highwire-citation-author" data-delta="9">J. Pile-Spellman</span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">May 2010,  </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">31 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(5) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">928-934; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata">DOI: https://doi.org/10.3174/ajnr.A1961 </span></div>
  
  
  
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      <div class="highwire-cite-title">Selective Brain Cooling with Endovascular Intracarotid Infusion of Cold Saline: A Pilot Feasibility Study</div>  
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    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0"><span class="nlm-given-names">J.H.</span> <span class="nlm-surname">Choi</span></span>, <span class="highwire-citation-author" data-delta="1"><span class="nlm-given-names">R.S.</span> <span class="nlm-surname">Marshall</span></span>, <span class="highwire-citation-author" data-delta="2"><span class="nlm-given-names">M.A.</span> <span class="nlm-surname">Neimark</span></span>, <span class="highwire-citation-author" data-delta="3"><span class="nlm-given-names">A.A.</span> <span class="nlm-surname">Konstas</span></span>, <span class="highwire-citation-author" data-delta="4"><span class="nlm-given-names">E.</span> <span class="nlm-surname">Lin</span></span>, <span class="highwire-citation-author" data-delta="5"><span class="nlm-given-names">Y.T.</span> <span class="nlm-surname">Chiang</span></span>, <span class="highwire-citation-author" data-delta="6"><span class="nlm-given-names">H.</span> <span class="nlm-surname">Mast</span></span>, <span class="highwire-citation-author" data-delta="7"><span class="nlm-given-names">T.</span> <span class="nlm-surname">Rundek</span></span>, <span class="highwire-citation-author" data-delta="8"><span class="nlm-given-names">J.P.</span> <span class="nlm-surname">Mohr</span></span>, <span class="highwire-citation-author" data-delta="9"><span class="nlm-given-names">J.</span> <span class="nlm-surname">Pile-Spellman</span></span></span></div>
  
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