Lutz Yannick, Daschner Rosa, Krames Lorena, Loewe Axel, Cattaneo Giorgio, Meckel Stephan, Dösse Olaf
Institute of Biomedical Engineering, Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany.
Adceris GmbH & Co KG, Pforzheim, Germany (now at University of Stuttgart, Stuttgart, Germany).
Math Biosci Eng. 2019 Nov 15;17(2):1147-1167. doi: 10.3934/mbe.2020060.
Therapeutic hypothermia (TH) is an approved neuroproctetive treatment to reduce neurological morbidity and mortality after hypoxic-ischemic damage related to cardiac arrest and neonatal asphyxia. Also in the treatment of acute ischemic stroke (AIS), which in Western countries still shows a very high mortality rate of about 25 %, selective mild TH by means of Targeted Temperature Management (TTM) could potentially decrease final infarct volume. In this respect, a novel intracarotid blood cooling catheter system has recently been developed, which allows for combined carotid blood cooling and mechanical thrombectomy (MT) and aims at selective mild TH in the affected ischemic brain (core and penumbra). Unfortunately, so far direct measurement and control of cooled cerebral temperature requires invasive or elaborate MRI-assisted measurements. Computational modeling provides unique opportunities to predict the resulting cerebral temperatures on the other hand. In this work, a simplified 3D brain model was generated and coupled with a 1D hemodynamics model to predict spatio-temporal cerebral temperature profiles using finite element modeling. Cerebral blood and tissue temperatures as well as the systemic temperature were analyzed for physiological conditions as well as for a middle cerebral artery (MCA) M1 occlusion. Furthermore, vessel recanalization and its effect on cerebral temperature was analyzed. The results show a significant influence of collateral flow on the cooling effect and are in accordance with experimental data in animals. Our model predicted a possible neuroprotective temperature decrease of 2.5 ℃ for the territory of MCA perfusion after 60 min of blood cooling, which underlines the potential of the new device and the use of TTM in case of AIS.
治疗性低温（TH）是一种已获批准的神经保护治疗方法，可降低与心脏骤停和新生儿窒息相关的缺氧缺血性损伤后的神经发病率和死亡率。在急性缺血性中风（AIS）的治疗中，西方国家的AIS死亡率仍高达约25%，通过目标温度管理（TTM）进行选择性轻度低温可能会减少最终梗死体积。在这方面，最近开发了一种新型颈内动脉血液冷却导管系统，该系统允许联合颈动脉血液冷却和机械血栓切除术（MT），旨在对受影响的缺血性脑（核心和半暗带）进行选择性轻度低温治疗。不幸的是，到目前为止，冷却后脑温度的直接测量和控制需要侵入性或复杂的MRI辅助测量。另一方面，计算建模提供了预测由此产生的脑温度的独特机会。在这项工作中，生成了一个简化的三维脑模型，并与一维血流动力学模型耦合，以使用有限元建模预测时空脑温度分布。分析了生理条件以及大脑中动脉（MCA）M1闭塞情况下的脑血温和组织温度以及全身温度。此外，还分析了血管再通及其对脑温度的影响。结果表明侧支血流对冷却效果有显著影响，并且与动物实验数据一致。我们的模型预测，血液冷却60分钟后，MCA灌注区域的神经保护温度可能会降低2.5℃，这突出了新设备以及在AIS情况下使用TTM的潜力。
