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RU-2861506-C1 - METHOD FOR SELECTING TREATMENT STRATEGY FOR HAEMORRHAGIC STROKE IN ACUTE PERIOD USING CRANIOCEREBRAL HYPOTHERMIA

RU2861506C1RU 2861506 C1RU2861506 C1RU 2861506C1RU-2861506-C1

Abstract

FIELD: medicine; neurology; neurosurgery. SUBSTANCE: invention can be used for the treatment of haemorrhagic stroke in the acute period. Determining the localisation of an intracerebral haematoma (ICH) by performing microwave radiometry and CT and/or MRI studies. Based on the obtained data, forming a 3D image of the head with the boundaries of the ICH and four anatomical regions - the right and left frontotemporal, the right and left parieto-occipital. Recording areas on the surface of the head with a temperature of 37°C and above, combining them with the projection of the ICH and determining the common boundary of the zone for craniocerebral hypothermia (CCH). Additionally, assessing the volume of the ICH, its depth, and the severity according to the NIHSS scale. Based on the obtained data, selecting a CCH mode. Upon completion of the procedure, heating the exposure zone to +15°C. EFFECT: increasing the effectiveness of treating moderate and severe haemorrhagic stroke according to the NIHSS scale in the acute period by preliminary assessment of a set of diagnostic criteria, allowing the selection of an optimal treatment regimen that determines the target zones for cold exposure, temperature and duration of exposure. 2 cl, 3 dwg, 3 tbl, 3 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
20250729

Claims (11)

  1. 1. A method for selecting a treatment strategy for hemorrhagic stroke in the acute period using craniocerebral hypothermia, including local cold exposure over the entire surface of the head or zonal cold exposure to a target area of the head surface, characterized in that before cold exposure, the localization of the intracerebral hematoma (ICH) is determined, for which purpose the temperature of the brain is measured using microwave thermometry, a CT and/or MRI study is performed, based on the CT and/or MRI results, a 3D image of the patient's head is formed with the designation of the boundaries of the ICH and the boundaries of at least four anatomical regions of the brain - the right frontotemporal region, the right parietal-occipital region, the left parietal-occipital region, the left frontotemporal region, based on the results of microwave thermometry, areas with a temperature of 37°C and above are recorded on the image of the surface of the patient's head, followed by combining the areas obtained from the results of microwave thermometry, with the area corresponding to the projection of the cerebral hemisphere on the surface of the head, and the determination of the general boundary of the zone for exposure to hypothermia on the surface of the head; the following parameters are determined on the obtained images:
  2. - the volume of the VMG according to its maximum value: less than 30 ml or 30-60 ml;
  3. - the depth of the location of the VMH relative to the surface of the head – deep and/or superficial structures;
  4. - anatomical areas that are affected by hypothermia on the surface of the head;
  5. additionally, the severity of neurological deficit is determined using the NIHSS scale;
  6. Hypothermia is carried out in the first 24 hours from the moment of development of hemorrhagic stroke using a helmet designed with the possibility of zonal cold exposure to the identified target anatomical areas on the surface of the head, while the hypothermia regime is determined on the basis of the obtained parameters:
  7. - in severe forms of hemorrhagic stroke - 16-24 points on the NIHSS with a hematoma volume of 30-60 ml and involvement of deep and superficial structures, local CCG with cooling to 4°C is used for 24-72 hours;
  8. - in case of moderate severity - 5-15 points on the NIHSS and hematomas of 30-60 ml, localized in deep structures, local CCG is used at a temperature of 5°C for 16-24 hours;
  9. - in case of moderate severity - 5-15 points on the NIHSS and hematomas up to 30 ml, localized in the superficial structures, zonal CCG is used with a temperature exposure of 5°C for 12-16 hours;
  10. After the CCG is carried out, the affected area is heated to +15°C.
  11. 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 hemorrhagic strokes, using local and/or zonal craniocerebral hypothermia aimed at protecting and restoring brain tissue and preventing the development of cerebral edema. 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 cerebrovascular pathologies, including hemorrhagic stroke, accounting for a significant proportion. Acute cerebrovascular accidents (ACEs) are the second leading cause of death, accounting for approximately 11% of all deaths. Hemorrhagic stroke, characterized by bleeding into the brain parenchyma or subarachnoid space, is associated with high rates of disability and mortality. Unlike ischemic stroke, where reperfusion therapy (thrombolysis and thrombectomy) has proven effective, there are no treatments with convincingly proven efficacy for the hemorrhagic form, with the exception of surgical interventions in individual cases. This necessitates the search for new therapeutic strategies aimed at neuroprotection and minimizing secondary brain damage [Ignatyeva V.I., Voznyuk I.A., Shamalov N.A. et al. Socioeconomic Burden of Stroke in the Russian Federation. Korsakov Journal of Neurology and Psychiatry. Special issues. 2023; 123 (82): 515]. One of the promising areas is local craniocerebral hypothermia, which demonstrates neuroprotective potential in various cerebral pathologies [Torosyan B.D., Butrov A.V., Shevelev O.A., Cheboksarov D.V., Artyukov O.P., Ustinskaya S.A., Sharinova I.A. Craniocerebral hypothermia is an effective means of neuroprotection in patients with cerebral infarction. Anesthesiology and reanimatology. 2018; (3): 58-63]. In hemorrhagic stroke, hypothermia can help reduce cerebral edema, reduce the inflammatory response and oxidative stress, which opens up new possibilities for pathogenetic therapy. Thus, the development of methods for local zonal craniocerebral hypothermia in hemorrhagic stroke is a relevant area of modern neuroreanimatology, requiring further experimental and clinical research. 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. Another known method of cooling the body is by cold infusions, which uses devices to reduce the main coolant - blood, including with the help of artificial 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): 4148]. 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. Saltanov Intensive Care Bulletin. 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. A more promising approach is craniocerebral hypothermia, which can be implemented either by cooling the entire surface of the head (local hypothermia) or through selective action on the lesion (zonal hypothermia). Compared to systemic methods, this approach minimizes the risk of systemic complications, while providing a more pronounced neuroprotective effect due to targeted action on the pathological focus (Torosyan B.D. et al., 2018). Modern experimental and clinical studies demonstrate that local hypothermia in hemorrhagic stroke helps to reduce perihematoma edema by 30-40%, suppress the neuroinflammatory cascade and reduce the area of secon