Method for treating ischemic brain stroke

• US 5,794,629 A
• Filed: 11/27/1996
• Issued: 08/18/1998
• Est. Priority Date: 11/27/1996
• Status: Expired due to Term

• Current Assignee: Regents of the University of California (University of California)
• Original Assignee: Regents of the University of California (University of California)
• Inventors: Frazee, John G.
• Primary Examiner(s): Millin, Vincent
• Assistant Examiner(s): O'Hara, Kelly
• Application Number:
  US08/757,303
• Time in Patent Office: 629 Days
• Field of Search: 128/898, 600/16, 600/18, 604/53
• US Class Current: 128/898
• CPC Class Codes: A61M 1/3613 Reperfusion, e.g. of the coronary vessels, e.g. retroperfusion
• CPC Class Codes: A61M 1/3621 Extra-corporeal blood circuits single-needle circuits A61M1/30
• CPC Class Codes: A61M 1/369 Temperature treatment
• CPC Class Codes: A61M 2205/366 by liquid heat exchangers
• CPC Class Codes: A61M 2210/0693 Brain, cerebrum

Abstract

A method for treating a patient sustaining an acute ischemic stroke in the brain. The brain has a blood circulatory system including a torcular Herophili and first and second transverse venous sinuses adjoining the torcular Herophili. The method comprises at least partially occluding the first and second transverse venous sinuses in first and second locations, respectively, adjacent to the torcular Herophili to partially obstruct venous blood drainage while permitting some antegrade venous blood flow from at least one of the transverse venous sinuses. A flow of the patient'"'"'s arterial blood is introduced into at least one of the transverse venous sinuses to provide a substantially continuous retrograde blood flow into the venous side of the brain of the patient to overcome the lack of arterial blood flow for a period of time until the patient exhibits at least some resolution of ischemic brain symptoms.

Claims

1. A method for treating a patient sustaining an acute ischemic stroke in the brain, the brain having a blood circulatory system including a torcular Herophili and first and second transverse venous sinuses adjoining the torcular Herophili, the method comprising at least partially occluding the first and second transverse venous sinuses in first and second locations respectively adjacent to the torcular Herophili to partially obstruct venous blood drainage while controlling the degree of said at least partially occluding the first and second transverse venous sinuses to permit some antegrade venous blood flow from at least one of said transverse venous sinuses and introducing a flow of the patient'"'"'s arterial blood into at least one of said transverse venous sinuses distal to said locations to provide a substantially continuous retrograde blood flow into the venous side of the brain of the patient to overcome the lack of arterial blood flow for a period of time until the patient exhibits at least some resolution of ischemic brain symptoms.

2. A method as in claim 1 wherein the step of partially occluding the first and second transverse venous sinuses in said locations permits antegrade venous blood flow from said first and second transverse venous sinuses.

3. A method as in claim 1 further comprising the step of measuring pressure in at least one of the first and second transverse venous sinuses and controlling the degree of said partially occluding of said at least one of the first and second transverse venous sinuses in accordance with the measured pressure.

4. A method as in claim 3 further comprising controlling the flow of arterial blood into the transverse venous sinus in accordance with the measured pressure.

5. A method as in claim 3 further comprising maintaining said pressure in a range from 10 to 20 mm Hg.

6. A method as in claim 1 wherein the patient'"'"'s arterial blood flowing into the transverse venous sinus is controlled to flow at a rate between 50 cc/minute and 250 cc/minute.

7. A method as in claim 1 wherein the brain blood circulatory system further includes first and second superior petrosal sinuses and first and second superior anastomotic veins (Labbe'"'"'s veins), said method further comprising partially occluding first and second locations that are medial to the first and second superior petrosal sinuses respectively and medial to the first and second superior anastamotic veins (Labbe'"'"'s veins) respectively.

8. A method as in claim 1 wherein flow of arterial blood from the patient'"'"'s femoral artery is introduced into at least one of the transverse venous sinuses distal to said occluding locations.

9. A method as in claim 1 where by the use of first and second balloon catheters having proximal and distal extremities and having inflatable balloons on the distal extremities and wherein said first and second transverse venous sinuses are partially occluded by introducing the distal extremity of the first balloon catheter into said first location, introducing the distal extremity of the second balloon catheter into the second location and inflating the balloons of the first and second balloon catheters.

10. A method as in claim 9 wherein the blood circulatory system further includes first and second venous vessels remote from the brain and wherein the distal extremities of the first and second balloon catheters are introduced into the first and second venous vessels respectively and thence into said first and second transverse venous sinus locations respectively.

11. A method as in claim 9 further comprising measuring at least one of the transverse venous sinus'"'"'s pressure and controlling the degree of inflation and deflation of the balloons in accordance with the measured pressure.

12. A method as in claim 1 further comprising obtaining a CAT scan prior to occluding said first and second transverse venous sinuses and aborting the procedure if the scan shows evidence of cerebral hemorrhage.

13. A method as in claim 1 further comprising selecting patients with Toronto Stroke scale scores of two or greater, at least one and less than seven hours after onset of stroke symptoms and signs.

14. A method as in claim 1 further comprising introducing at least one pharmacological agent into said at least one of the transverse venous sinuses distal to said locations to provide an infusion of said at least one agent directly into otherwise inaccessible ischemic areas of the brain.

15. A method for treating a patient sustaining an acute ischemic stroke in the brain, the brain having a blood circulatory system including a torcular Herophili and first and second transverse venous sinuses adjoining the torcular Herophili, the method comprising at least partially occluding the first and second transverse venous sinuses in first and second locations respectively adjacent to the torcular Herophili to partially obstruct venous blood drainage while controlling the degree of said at least partially occluding the first and second transverse venous sinuses to permit antegrade venous blood flow from at least one of said transverse venous sinuses so that it is within 10% to 50% of normal flow and introducing a flow of the patient'"'"'s arterial blood into at least one of said transverse venous sinuses distal to said locations to provide a substantially continuous retrograde blood flow into the venous side of the brain of the patient to overcome the lack of arterial blood flow for a period of time until the patient exhibits at least some resolution of ischemic brain symptoms.

16. A method for treating a patient sustaining an acute ischemic stroke in the brain, the brain having a blood circulatory system including a torcular Herophili and first and second transverse venous sinuses adjoining the torcular Herophili, the method comprising at least partially occluding the first and second transverse venous sinuses in first and second locations respectively adjacent to the torcular Herophili to partially obstruct venous blood drainage while controlling the degree of said at least partially occluding the first and second transverse venous sinuses to permit antegrade venous blood flow from at least one of said transverse venous sinuses and introducing a flow of the patient'"'"'s arterial blood into at least one of said transverse venous sinuses distal to said locations causing the patient'"'"'s arterial blood initially to flow into the transverse venous sinus at a rate of 10 cc/minute and increasing the flow to 50-250 cc/minute over a period of time ranging from 3 to 10 minutes to provide a substantially continuous retrograde blood flow into the venous side of the brain of the patient to overcome the lack of arterial blood flow for a period of time until the patient exhibits at least some resolution of ischemic brain symptoms.

17. A method for treating a patient sustaining an acute ischemic stroke in the brain, the brain having a blood circulatory system including a torcular Herophili and first and second transverse venous sinuses adjoining the torcular Herophili, the method comprising at least partially occluding the first and second transverse venous sinuses from twenty-five per cent to seventy per cent of complete occlusion in first and second locations respectively adjacent to the torcular Herophili to partially obstruct venous blood drainage while controlling the degree of said at least partially occluding the first and second transverse venous sinuses to permit some antegrade venous blood flow from at least one of said transverse venous sinuses and introducing a flow of the patient'"'"'s arterial blood into at least one of said transverse venous sinuses distal to said locations to provide a substantially continuous retrograde blood flow into the venous side of the brain of the patient to overcome the lack of arterial blood flow for a period of time until the patient exhibits at least some resolution of ischemic brain symptoms.

18. A method for treating a patient undergoing brain aneurysm clipping and brain tumor resection requiring arterial inflow occlusion, the brain having a blood circulatory system including a torcular Herophili and first and second transverse venous sinuses adjoining the torcular Herophili, the method comprising at least partially occluding the first and second transverse venous sinuses in first and second locations respectively, adjacent to the torcular Herophili to partially obstruct venous blood drainage while controlling the degree of said at least partially occluding the first and second transverse venous sinuses to permit some antegrade venous blood flow from at least one of said transverse venous sinuses and introducing a flow of the patient'"'"'s arterial blood into at least one of said transverse venous sinuses distal to said locations to provide a substantially continuous retrograde blood flow into the venous side of the brain of the patient to overcome the lack of arterial blood flow for a period of time until the arterial inflow occlusion is relieved.

19. A method for treating a patient sustaining a non-hemorrhagic angiographic injury in the brain, the brain having a blood circulatory system including a torcular Herophili and first and second transverse venous sinuses adjoining the torcular Herophili, the method comprising at least partially occluding the first and second transverse venous sinuses in first and second locations respectively, adjacent to the torcular Herophili to partially obstruct venous blood drainage while controlling the degree of said at least partially occluding the first and second transverse venous sinuses to permit some antegrade venous blood flow from at least one of said transverse venous sinuses and introducing a flow of the patient'"'"'s arterial blood into at least one of said transverse venous sinuses distal to said locations to provide a substantially continuous retrograde blood flow into the venous side of the brain of the patient to overcome the lack of arterial blood flow for a period of time until the patient exhibits at least some resolution of brain injury symptoms.

20. A method for treating a patient sustaining an acute ischemic stroke in the brain, the brain having a blood circulatory system comprising a torcular Herophili, first and second transverse venous sinuses adjoining the torcular Herophili, the patient having first and second venous vessels remote from the brain, by the use of first and second balloon catheters having proximal and distal extremities and having inflatable balloons on the distal extremities, the method comprising introducing the distal extremity of the first balloon catheter into the first vessel and thence into the first transverse venous sinus into close proximity to the torcular Herophili, introducing the distal extremity of the second balloon catheter into the second vessel and thence into the second transverse venous sinus into close proximity to the torcular Herophili, at least partially inflating the balloons of the first and second balloon catheters to at least partially occlude the first and second transverse sinuses while controlling the degree of said at least partially occluding the first and second transverse venous sinuses to permit antegrade flow from at least one of the transverse venous sinuses to prevent excessive pressure buildup in the transverse venous sinus, introducing a flow of the patient'"'"'s arterial blood into at least one of the transverse venous sinuses distal to the balloon positioned in that transverse venous sinus to provide a substantially continuous retrograde blood flow into the venous side of the brain of the patient to overcome the lack of arterial blood flow, for a period of time up to when the patient exhibits resolution of at least some of the ischemic brain symptoms.

21. A method as in claim 20 further comprising measuring at least one of the transverse venous sinus'"'"'s pressure and controlling the degree of inflation and deflation of the balloons in accordance with the measured pressure.

22. A method as in claim 20 further comprising introducing at least one pharmacological agent into said at least one of the transverse venous sinuses distal to said balloon positioned in that transverse venous sinus to provide an infusion of said at least one agent directly into otherwise inaccessible ischemic areas of the brain.

23. A method for treating a patient sustaining an acute ischemic stroke in the brain, the brain having a blood circulatory system including a plurality of venous sinuses, the method comprising at least partially occluding first and second venous sinuses in first and second locations to partially obstruct venous blood drainage while controlling the degree of said at least partially occluding first and second venous sinuses to permit some antegrade venous blood flow from at least one of said first and second venous sinuses and introducing a flow of the patient'"'"'s arterial blood into at least one of said first and second venous sinuses distal to said locations to provide a substantially continuous retrograde blood flow into the venous side of the brain of the patient to overcome the lack of arterial blood flow for a period of time until the patient exhibits at least some resolution of ischemic brain symptoms.

24. A method as in claim 23 wherein by the use of first and second balloon catheters having proximal and distal extremities and having inflatable balloons on the distal extremities, said first and second venous sinuses are partially occluded by introducing the distal extremity of the first balloon catheter into said first location, introducing the distal extremity of the second balloon catheter into the second location and inflating the balloons of the first and second balloon catheters.

25. A method for treating a patient sustaining an acute ischemic stroke in the brain, the brain having a blood circulatory system including a plurality of venous sinuses, the method comprising at least partially occluding first and second venous sinuses in first and second locations from five per cent to ninety-nine per cent of complete occlusion to obstruct venous blood drainage from said first and second venous sinuses and introducing a flow of the patient'"'"'s arterial blood into at least one of said first and second venous sinuses distal to said locations to provide a substantially continuous retrograde blood flow into the venous side of the brain of the patient to overcome the lack of arterial blood flow for a period of time until the patient exhibits at least some resolution of ischemic brain symptoms.

26. A method for treating a patient undergoing brain aneurysm clipping and brain tumor resection requiring arterial inflow occlusion, the brain having a blood circulatory system including a plurality of venous sinuses, the method comprising at least partially occluding first and second venous sinuses in first and second locations respectively, to partially obstruct venous blood drainage while controlling the degree of said at least partially occluding first and second venous sinuses to permit some antegrade venous blood flow from at least one of said first and second venous sinuses and introducing a flow of the patient'"'"'s arterial blood into at least one of said first and second venous sinuses distal to said locations to provide a substantially continuous retrograde blood flow into the venous side of the brain of the patient to overcome the lack of arterial blood flow for a period of time until the arterial inflow occlusion is relieved.

27. A method for treating a patient sustaining an acute ischemic stroke in the brain, the brain having a blood circulatory system including a torcular Herophill and first and second transverse venous sinuses adjoining the torcular Herophili, the method comprising introducing a substantially continuous retrograde flow of patient'"'"'s arterial blood into at least one of said transverse venous sinuses and into the venous side of the brain of the patient to overcome the lack of arterial blood flow at least partially occluding at lest one of the first and second transverse venous sinuses to permit some antegrade venous blood flow to prevent excessive pressure buildup in said transverse venous sinuses for a period of time until the patient exhibits at least some resolution of ischemic brain symptoms.

28. A method as in claim 27 further comprising the step of measuring pressure in at least one of the first and second transverse venous sinuses and controlling the amount of antegrade blood flow in accordance with the measured pressure.

29. A method as in claim 28 further comprising maintaining said pressure in a range from 10 to 20 mm Hg.

30. A method for treating a patient sustaining an acute ischomic stroke in the brain, the brain having a blood circulatory system including a plurality of venous sinuses, the method comprising introducing a substantially continuous retrograde flow of patient'"'"'s arterial blood into at least one of said venous sinuses and Into the venous side of the brain of the patient to overcome the lack of arterial blood flow at least partially occluding at least one of the first and second transverse venous sinuses to permit some antegrade venous blood flow to prevent excessive pressure buildup in said transverse venous sinuses for a period of time until the patient exhibits at least some resolution of ischemic brain symptoms.