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.
In Western countries, stroke is the third-most cause of death; 35- 55% of the survivors experience permanent disability. Mild therapeutic hypothermia (TH) showed neuroprotective effect in patients returning from cardiac arrest and is therefore assumed to decrease stroke induced cerebral damage. Recently, an intracarotid cooling sheath was developed to induce local TH in the penumbra using the cooling effect of cerebral blood flow via collaterals. Computational modeling provides unique opportunities to predict the resulting cerebral temperature without invasive procedures. In this work, we generated a simplified brain model to establish a cerebral temperature calculation using Pennes’ bio-heat equation and a 1D hemodynamics model of the cranial artery tree. In this context, we performed an extensive literature research to assign the terminal segments of the latter to the corresponding perfused tissue. Using the intracarotid cooling method, we simulated the treatment with TH for different degrees of stenosis in the middle cerebral artery (MCA) and analyzed the resulting temperature spatialtemporal distributions of the brain and the systemic body considering the influence of the collaterals on the effect of cooling.
Stroke is the third-most cause of death in developed countries. A new promising treatment method in case of an ischemic stroke is selective intracarotid blood cooling combined with mechanical artery recanalization. However, the control of the treatment requires invasive or MRI-assisted measurement of cerebral temperature. An auspicious alternative is the use of computational modeling. In this work, we extended an existing 1D hemodynamics model including the characteristics of the anterior, middle and posterior cerebral artery. Furthermore, seven ipsilateral anastomoses were additionally integrated for each hemisphere. A potential stenosis was placed into the M1 segment of the middle cerebral artery, due to the highest risk of occlusion there. The extended model was evaluated for various degrees of collateralization (“poor”, “partial” and “good”) and degrees of stenosis (0%, 50%, 75% and 99.9%). Moreover, cerebral autoregulation was considered in the model. The higher the degree of collateralization and the degree of stenosis, the higher was the blood flow through the collaterals. Hence, a patient with a good collateralization could compensate a higher degree of occlusion and potentially has a better outcome after an ischemic stroke. For a 99.9% stenosis, an increased summed mean blood flow through the collaterals of +97.7% was predicted in case of good collateralization. Consequently, the blood supply via the terminal branches of the middle cerebral artery could be compensated up to 44.4% to the physiological blood flow. In combination with a temperature model, our model of the cerebral collateral circulation can be used for tailored temperature prediction for patients to be treated with selective therapeutic hypothermia.
Y. Lutz, R. Daschner, L. Krames, A. Loewe, O. Dössel, and G. Cattaneo. Estimating Local Therapeutic Hypothermia in Case of Ischemic Stroke Using a 1D Hemodynamics Model and an Energetic Temperature Model. In 41st Annual International Conference of the IEEE Engineering in Medicine and Biology Society (EMBC), pp. 3983-3986, 2019
In Western countries, stroke is the third-most widespread cause of death. 80% of all strokes are ischemic and show a mortality rate of about 25%. Furthermore, 35-55% of affected patients retain a permanent disability. Therapeutic hypothermia (TH) could decrease inflammatory processes and the stroke-induced cerebral damage. Currently, the standard technique to induce TH is cooling of the whole body, which can cause several side effects. A novel cooling sheath uses intra-carotid blood cooling to induce local TH. Unfortunately, the control of the temporal and spatial cerebral temperature course requires invasive temperature measurements. Computational modeling could be used to predict the resulting temperature courses instead. In this work, a detailed 1D hemodynamics model of the cerebral arterial system was coupled with an energetic temperature model. For physiological conditions, 50% and 100% M1-stenoses, the temperatures in the supply area of the middle cerebral artery (MCA) and of the systemic body was analyzed. A 2K temperature decrease was reached within 10min of cooling for physiological conditions and 50% stenosis. For 100% stenosis, a significant lower cooling effect was observed, resulting in a maximum cerebral temperature decrease of 0.7K after 30min of cooling. A significant influence of collateral flow rates on the cooling effect was observed. However, regardless of the stenosis degree, the temperature decrease was strongest within the first 20min of cooling, which demonstrates the fast and effective impact of intra-carotid blood cooling.
Student Theses (1)
R. Daschner. Generation of a Simplified Brain Geometry for the Calculation of Local Cerebral Temperature using a 1D-Hemodynamics Model. Institute of Biomedical Engineering, Karlsruhe Institute of Technology (KIT). Bachelorarbeit. 2018
In western countries, stroke is the third-most widespread cause of death. 80% of all strokes are ischemic and caused by a cerebral thrombosis or an embolism. The mortality rate of ischemic strokes is about 25%, while 35–55% of affected patients experience permanent disability. Therapeutic hypothermia (TH) showed neuroprotective effect and can possibly decrease the stroke induced cerebral damage. Recently, an intracarotid cooling sheath was developed to induce local TH in the penumbra using the cooling effect of cranial blood flow via collaterals. Unfortunately, so far the control and regulation of the temporal and spatial cerebral temperature course is connected to invasive temperature measurements. Computational modeling provides unique opportunities to predict the resulting tempera- ture decrease of the brain tissue and could replace the invasive procedure. In this work a simplified brain model was generated to establish a cerebral temperature calculation using Pennes’ Bio-Heat-Equation and an existing cerebral hemodynamics model. In this context, an extensive literature research was performed and the terminal segments of the hemodynamics model were assigned to corresponding perfused brain tissue. For different degrees of stenosis in the MCA, TH was simulated using the intracarotid cooling method and local temperature curves and blood temperatures in the brain were analyzed. The lower the degree of stenosis, the faster and stronger a cooling could be achieved. Fur- thermore, the simulation results showed a significant influence of collateral flows on the penumbra cooling and the need to model different tissue types for simulation of the local brain temperature could be demonstrated. The anastomoses between the ACA and MCA had a cooling effect on the penumbra in addition to the blood flow from the internal carotid artery. The temperature model can be used in conjunction with the hemodynamic model to simulate the inducation of TH. It has been shown that for patients with the physical properties used in this work, intracarotid cooling in case of high degrees of stenosis is not sufficient to reach TH in the penumbra within one hour. In future simulation studies the influence of variations of the Circulus Willisii and anastomoses on cerebral cooling should be investigated.