A new technique allowing prolonged temporary cerebral artery occlusion.
OBJECTIVE
Clipping of complex cerebral aneurysms often requires temporary vessel occlusion. The risk of stroke, however, increases exponentially with occlusion time. The authors hypothesized that prolonged temporary occlusion might be tolerated if the occluded vessels were perfused with cold physiological saline solution (CPSS). A low-flow perfusion rate would permit surgical manipulation of an aneurysm distal to the occlusion.


METHODS
To test this hypothesis, the authors temporarily occluded the middle cerebral artery (MCA) with an endovascular catheter in 6 rats. Three animals, the treatment group, were perfused with 5-ml CPSS/hour through the occluding endovascular catheter into the MCA, and the other 3 served as an ischemic control group. In both groups, the catheter was removed after 90 minutes of occlusion. The brain temperature was monitored with a stereotactically placed probe in the caudate-putamen in 2 separate experimental groups (11 animals).


RESULTS
Magnetic resonance imaging perfusion scanning during vessel occlusion confirmed similar reduction of cerebral blood flow during MCA occlusion in both the simple-occlusion and perfusion-occlusion groups. Magnetic resonance imaging diffusion scans performed 24 hours after temporary occlusion revealed infarcts in the ischemic control group of 138.3 +/- 28.0 mm(3) versus 9.9 +/- 9.9 mm(3) in the cold saline group (p < 0.005). A focal cooling effect during perfusion with CPSS was demonstrated (p < 0.05).


CONCLUSIONS
Prolonged temporary cerebral vessel occlusion can be tolerated using superselective CPSS perfusion through an occluding endovascular catheter into the ischemic territory. This technique could possibly be applied in neurosurgery practice to the management of complex intracranial aneurysms.
Hauck
Erik F
EF
Division of Neurosurgery, University of Texas Medical Branch at Galveston, Texas, USA. erik.hauck@utsouthwestern.edu
Wei
Jingna
J
Quast
Michael J
MJ
Nauta
Haring J W
HJ
D000818:Animals; D001831:Body Temperature / Q000502:physiology; D001921:Brain / Q000502:physiology; D002561:Cerebrovascular Disorders / Q000503:physiopathology*; D002532:Intracranial Aneurysm / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008297:Male; D020768:Middle Cerebral Artery / Q000187:drug effects* / Q000503:physiopathology*; D023421:Models, Animal; D010477:Perfusion; D051381:Rats; D017207:Rats, Sprague-Dawley; D012307:Risk Factors; D012965:Sodium Chloride / Q000008:administration & dosage / Q000494:pharmacology*; D020521:Stroke / Q000517:prevention & control; D013525:Surgical Instruments
D012965:Sodium Chloride