A Pilot Study of Normobaric Oxygen Therapy in Acute Ischemic Stroke
ABSTRACT Therapies that transiently prevent ischemic neuronal death can potentially extend therapeutic time windows for stroke thrombolysis. We conducted a pilot study to investigate the effects of high-flow oxygen in acute ischemic stroke.
We randomized patients with acute stroke (<12 hours) and perfusion-diffusion "mismatch" on magnetic resonance imaging (MRI) to high-flow oxygen therapy via facemask for 8 hours (n=9) or room air (controls, n=7). Stroke scale scores and MRI scans were obtained at baseline, 4 hours, 24 hours, 1 week, and 3 months. Clinical deficits and MR abnormalities were compared between groups.
Stroke scale scores were similar at baseline, tended to improve at 4 hours (during therapy) and 1 week, and significantly improved at 24 hours in hyperoxia-treated patients. There was no significant difference at 3 months. Mean (+/-SD) relative diffusion MRI lesion volumes were significantly reduced in hyperoxia-treated patients at 4 hours (87.8+/-22% versus 149.1+/-41%; P=0.004) but not subsequent time points. The percentage of MRI voxels improving from baseline "ischemic" to 4-hour "non-ischemic" values tended to be higher in hyperoxia-treated patients. Cerebral blood volume and blood flow within ischemic regions improved with hyperoxia. These "during-therapy" benefits occurred without arterial recanalization. By 24 hours, MRI showed reperfusion and asymptomatic petechial hemorrhages in 50% of hyperoxia-treated patients versus 17% of controls (P=0.6).
High-flow oxygen therapy is associated with a transient improvement of clinical deficits and MRI abnormalities in select patients with acute ischemic stroke. Further studies are warranted to investigate the safety and efficacy of hyperoxia as a stroke therapy.
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ABSTRACT: Normobaric hyperoxia (NBO), which maintains penumbral oxygenation, reduces brain injury during cerebral ischemia, and minocycline, a tetracycline derivative, reduces reperfusion injury, including inflammation, apoptosis and matrix metalloproteinases (MMPs) activation. Since they have different mechanisms of action, we hypothesized that combining them would provide greater neuroprotection. To test the hypothesis, we evaluated the neuroprotective effects of the combination of NBO with minocycline. Male Sprague Dawley rats were exposed to NBO (95% O(2)) or normoxia (21% O(2)) during 90-min filament occlusion of the middle cerebral artery, followed by 48hrs of reperfusion. Minocycline (3mg/kg) or vehicle was intravenously administered to rats 15min after reperfusion onset. Treatment with NBO and minocycline alone resulted in 36% and 30% reductions in infarction volume, respectively. When the two treatments were combined, there was a 68% reduction in infarction volume. The combination therapy also significantly reduced hemispheric swelling, which was absent with monotherapy. In agreement with its greater neuro- and vasoprotection, the combination therapy showed greater inhibitory effects on MMP-2/9 induction, occludin degradation, caspase-3 and -9 activation and apoptosis inducing factor (AIF) induction in ischemic brain tissue. Our results show that NBO plus minocycline effectively reduces brain injury in transient focal cerebral ischemia with protection due to inhibition on MMP-2/9-mediated occludin degradation and attenuation of caspase-dependent and independent apoptotic pathways.Experimental Neurology 11/2012; 240. DOI:10.1016/j.expneurol.2012.11.018 · 4.62 Impact Factor
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ABSTRACT: Studies suggest that neuroprotective effects of normobaric oxygen (NBO) therapy in acute stroke are partly mediated by hemodynamic alterations. We investigated cerebral hemodynamic effects of repeated NBO exposures. Serial magnetic resonance imaging (MRI) was performed in Wistar rats subjected to focal ischemic stroke. Normobaric oxygen-induced functional cerebral blood volume (fCBV) responses were analyzed. All rats had diffusion-weighted MRI (DWI) lesions within larger perfusion deficits, with DWI lesion expansion after 3 hours. Functional cerebral blood volume responses to NBO were spatially and temporally heterogeneous. Contralateral healthy tissue responded consistently with vasoconstriction that increased with time. No significant responses were evident in the acute DWI lesion. In hypoperfused regions surrounding the acute DWI lesion, tissue that remained viable until the end of the experiment showed relative preservation of mean fCBV at early time points, with some rats showing increased fCBV (vasodilation); however, these regions later exhibited significantly decreased fCBV (vasoconstriction). Tissue that became DWI abnormal by study-end initially showed marginal fCBV changes that later became moderate fCBV reductions. Our results suggest that a reverse-steal hemodynamic effect may occur in peripheral ischemic zones during NBO treatment of focal stroke. In addition, CBV responses to NBO challenge may have potential as an imaging marker to distinguish ischemic core from salvageable tissues.Journal of cerebral blood flow and metabolism: official journal of the International Society of Cerebral Blood Flow and Metabolism 06/2012; 32(9):1800-9. DOI:10.1038/jcbfm.2012.87 · 5.34 Impact Factor
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ABSTRACT: Manipulation of inhaled gases during ischemia/reperfusion is a potential novel therapy for acute stroke. We previously found that treatment with a mixture of 70%/30% helium/oxygen (heliox) or 100% oxygen protects the brain against acute focal ischemia-reperfusion injury. This study evaluates the potential neuro-protective effects of delayed heliox treatment and its dose response effects in a rat transient focal cerebral ischemia model. Adult male rats were subjected to 2-h middle cerebral artery occlusion and then assigned to 1 of 4 inhaled gas exposure groups: I: 70%/30% nitrogen/oxygen (control); II: 70%/30% helium/oxygen administered immediately after occlusion; III: 70%/30% helium/oxygen administered after a 30-60 min delay; or, IV: 40%/30%/30% nitrogen/helium/oxygen administered immediately after occlusion. Outcome measurements included infarct size and neurological deficit score. Mean infarct sizes from groups I to IV were 228, 35, 109, and 124 mm³ respectively (p=0.012). Only group II had significantly smaller infarct size compared to the control group (p=0.008). In addition, only Group II had a significantly lower neurological deficit score at 24h post ischemia when compared to the control group (p<0.001). Since heliox reduced infarct size and improved neurological deficit scores if initiated immediately after onset of ischemia, it may be a useful adjuvant to other stroke therapies.Neuroscience Letters 06/2011; 497(2):144-7. DOI:10.1016/j.neulet.2011.04.048 · 2.06 Impact Factor