JVS - Vascular Science (Jan 2021)
Transrectal intracolon cooling prevents paraplegia and mortality in a rat model of aortic occlusion-induced spinal cord ischemia
Abstract
Objective: Spinal cord ischemia–reperfusion injury (SC-IRI) occurs in many medical conditions such as aneurysm surgical repair but no treatment of SC-IRI is available in clinical practice. The objective of the present study was to develop a novel medical device for the treatment of SC-IRI. Methods: A rat model of SC-IRI was used. A novel transrectal intracolon (TRIC) temperature management device was developed to maintain an intracolon wall temperature at either 37°C (TRIC37°C) or 12°C (TRIC12°C). The upper body temperature was maintained as close as possible to 37°C in both groups. A 2F Fogarty balloon catheter was inserted via the left common carotid artery to block the distal aortic blood flow to the spinal cord. The proximal blood pressure was controlled by the withdrawal and infusion of blood via the jugular vein catheter, such that the distal tail artery blood pressure was maintained at ∼10 mmHg for 13 and 20 minutes, respectively. Next, the balloon was deflated, and TRIC temperature management was continued for an additional 30 minutes to maintain the colon wall temperature at either 37°C or 12°C during the reperfusion period. Results: All the rats subjected to 13 minutes of spinal cord ischemia in the TRIC37°C group had developed paraplegia during the postischemic phase. In striking contrast, TRIC at 12°C completely prevented the paraplegia, dramatically improved the arterial blood gas parameters, and avoided the histopathologic injuries to the spinal cord in rats subjected to 13 minutes of spinal cord ischemia. Furthermore, TRIC12°C allowed for the extension of the ischemia duration from 13 minutes to 20 minutes, with significantly reduced functional deficits. Conclusions: Directly cooling the intestine focally with the TRIC device offered an exceptional survival rate and functional improvement after aortic occlusion-induced spinal cord ischemia. : Clinical Relevance: The present study showed that the use of the transrectal intracolon (TRIC) device to directly cool the intestine offers outstanding clinical benefits against spinal cord ischemia–reperfusion injury and prevents mortality in the rat aortic occlusion spinal cord ischemia model. The translational value of the present study could be high because the protection was so dramatic, the TRIC device is easy to use, and the TRIC cooling adverse effects were minimal. This novel TRIC management modality can offer fast cooling of the gut from 37°C to 12°C within 5 minutes, and the upper body temperature can be maintained in a tolerable temperature range, minimizing the fatal adverse effects of whole-body deep cooling.
