RU-2861503-C1 - METHOD FOR SELECTING TREATMENT STRATEGY FOR ISCHAEMIC STROKE IN ACUTE PERIOD USING CRANIOCEREBRAL HYPOTHERMIA

Abstract

FIELD: medicine; neurology; neurosurgery. SUBSTANCE: invention can be used for the treatment of ischaemic stroke in the acute period using craniocerebral hypothermia. Based on microwave radiometry, CT, MRI and CT-angiography data, a 3D model of the head is formed with the identification of four anatomical regions and the projection of the pathological focus. The degree of arterial stenosis, the size and depth of the focus are determined. By combining hyperthermia zones with the projection of the focus on the surface of the head, the boundaries of the target zone for hypothermia exposure are determined. In the first 24 hours, zonal or local cold exposure is performed using a helmet in special modes depending on the identified parameters, followed by heating the zone to +15°C. EFFECT: increasing the effectiveness of treatment and reducing the risk of side effects by accurately determining the boundaries of the pathological focus and selecting individual hypothermia parameters, which makes it possible to limit the cold exposure to the affected area without affecting healthy tissues, reduce the metabolic activity of neurons and accelerate the recovery of lost functions. 2 cl, 3 dwg, 3 tbl, 4 ex

Inventors

• Vekilyan Mikhail Arturovich
• Artyukov Oleg Petrovich
• Safonova Anastasiya Yaroslavovna
• Migunova Irina Aleksandrovna
• Dulatova Indira Ismailovna
• Mandrik Larisa Viktorovna
• Maksudova Elmira Maksudovna
• Syrchenko Nikolaj Vladimirovich

Dates

Publication Date

20260505

Application Date

20250720

Claims (9)

1. 1. A method for selecting treatment tactics for ischemic stroke in the acute period using craniocerebral hypothermia - local, in which cold exposure is carried out over the entire surface of the head, or zonal, in which cold exposure is carried out on the target area of the surface of the head, characterized in that
2. before cold exposure, the localization of the lesion is determined by measuring the temperature of the brain using microwave thermometry, performing a CT and/or MRI study, CT angiography, clinically determining the basin of one or more affected arteries and structures of the brain, based on the results of CT and/or MRI, a 3D image of the patient's head is formed with the designation of the pathological lesion and the boundaries of at least four anatomical regions of the brain - the right frontotemporal region (RFTR), the right parietooccipital region (RPOR), the left parietooccipital region (LPOR), the left frontotemporal region (LFTR), after which, based on the results of microwave thermometry, areas with a temperature of 37°C and higher are recorded on the image of the surface of the patient's head, with subsequent combination of the areas obtained from the results of microwave thermometry with the area corresponding to the projection of the pathological lesion on the surface of the head, after which the general boundary of the zone for exposure is determined on the surface of the head on the 3D image hypothermia with the definition of target anatomical areas in which this boundary falls;
3. in this case, they determine:
4. - the degree of stenosis with overlap of the afferent artery by an atherosclerotic plaque: less than 50%, from 50 to 75% inclusive, more than 75%;
5. - the size of the ischemic stroke focus according to its maximum value: small - less than 2 cm, medium - from 2 to 4 cm inclusive, large - more than 4 cm;
6. - the depth of the lesion relative to the surface of the head - deep and/or superficial structures;
7. - anatomical areas that are affected by hypothermia on the surface of the head;
8. In this case, hypothermia is carried out on the first day from the moment of the development of a stroke using a helmet designed with the possibility of zonal cold exposure to the identified target anatomical areas on the surface of the head using modes in accordance with Table 1 presented in the description, with subsequent heating of the exposure zone to +15°C.
9. 2. The method according to paragraph 1, characterized in that if, after hypothermia on the third or fifth day from the moment of development of the stroke, the clinical picture of cerebral edema persists or increases, a repeated local exposure to hypothermia is carried out for 16 hours at an exposure temperature of +5°C.

Description

Field of technology to which the invention relates The invention pertains to the field of medicine, specifically to the treatment of acute cerebrovascular accidents (ACVA), particularly ischemic strokes, using local and/or zonal craniocerebral hypothermia aimed at protecting and restoring brain tissue. The invention can be used in primary vascular departments and regional vascular centers. State of the art In recent years, there has been an increase in cardiovascular diseases, with a high proportion of ischemic strokes. Acute cerebrovascular accidents (ACE) rank second among all causes of death, accounting for approximately 11% of all deaths [Ignatyeva V.I., Voznyuk I.A., Shamalov N.A. et al. Socioeconomic burden of stroke in the Russian Federation. S.S. Korsakov Journal of Neurology and Psychiatry. Special issues. 2023; 123 (82): 515]. The lack of proven effective therapy (other than revascularization for a limited period of time) requires a search for new treatment methods for ACE. Hypothermia, or cooling, is of interest as a potential treatment for acute cerebrovascular accidents (ACE), in particular, ischemic stroke. Brain cooling can reduce neuronal damage caused by a lack of blood supply and oxygen and reduce the negative consequences of stroke. The prior art indicates the use of systemic (general) hypothermia and craniocerebral hypothermia in the treatment of stroke. General therapeutic hypothermia is achieved by removing heat from large areas of the body [Butrov A.V., Torosyan B.D., Cheboksarov D.V., Makhmutova G.R. Therapeutic hypothermia in brain lesions of various origins. A.I. Saltanov Bulletin of Intensive Care. 2019; (2): 75-81]. To maintain the required level of hypothermia, patients are covered with a wet sheet and exposed to a stream of room-temperature air. Devices for removing heat from large areas of the patient's body are also known. During general therapeutic hypothermia, the core body temperature is monitored; if the temperature drops below the threshold, cooling is stopped and the patient is rewarmed. A method of cooling the body with the help of cold infusions is also known, for which they use devices for lowering the main coolant - blood, including with the help of artificial blood circulation machines [Oshorov AV, Popugaev KA, Savin IA, et al. The use of intravascular hypothermia to correct intracranial hypertension in victims with severe traumatic brain injury. Journal of Neurosurgery named after N.N. Burdenko. 2014; 78 (5): 41-48]. The simplicity and availability of general therapeutic hypothermia allow it to be used today. However, when using general hypothermia, severe complications are possible leading to disruption of vital functions, for example, in the form of arterial hypotension, arrhythmia, bradycardia, severe water-electrolyte disturbances, coagulopathy, infectious complications [Polderman KH. Mechanisms of action, physiological effects, and complications of hypothermia. Crit Care Med. 2009 Jul;37(7 Suppl):S186-202; Butrov AV, Torosyan BD, Cheboksarov DV, Makhmutova GR. Therapeutic hypothermia in brain lesions of various origins. A.I. Saltanov Bulletin of Intensive Care. 2019;(2):75-81]. In particular, there are known cases of the appearance of characteristic signs of cardiovascular disorders on the ECG, namely: prolongation of the P-Q interval, the QRS complex, and arrhythmia. Craniocerebral hypothermia (CCH) is a promising approach to neuroprotection in acute cerebrovascular accidents, including ischemic and hemorrhagic stroke. Among the various technologies for its implementation in clinical practice, local and zonal craniocerebral hypothermia are of particular interest, differing in the extent and precision of their effects on the brain. Local craniocerebral hypothermia is traditionally performed by cooling the patient's entire scalp. Zonal craniocerebral hypothermia is aimed at selectively cooling areas of ischemic damage, minimizing the impact on healthy brain structures and reducing the risk of systemic side effects. The development of local and zonal craniocerebral hypothermia technologies using devices for cooling the cranial part of the head and devices for cooling the nasopharyngeal mucosa has made it possible to mitigate the side effects associated with general hypothermia while ensuring a sustainable neuroprotective effect. In particular, a method and device for performing local craniocerebral therapeutic hypothermia using the ATG-01 device (OOO Tsentrmed-Plus, Russia or OOO KrioTekhnoMed, Russia) are known from the prior art [Torosyan, B. D. Craniocerebral hypothermia in the acute period of ischemic stroke: dissertation ... of a candidate of medical sciences: 01/14/20 / Torosyan Bagrat Dzhonikovich; - Moscow, 2018. - 28 p.; Craniocerebral hypothermia as a method of treating disturbances in the temperature balance of the brain in patients in the post-coma period, O. A. Shevelev, Sh. Kh. Saidov, M. V. Petrova, M. A. Chubarova, E. Sh. Usmanov. Physical and r