Article preview from Medtech Insight Newsletter - October 2013
Therapeutic hypothermia has shown promise as a neuroprotective treatment for a variety of applications, including cardiac arrest and neonatal hypoxic brain injury. Now companies with temperature management technologies are conducting clinical trials and developing new cooling devices with an eye toward cooling the brain in patients who experience an acute ischemic stroke – an indication with an estimated worldwide market potential of $3 billion annually.
Cooling The Brain: New Therapies For Stroke
Article preview from Medtech Insight Newsletter - October 2013
Medical device start-ups are surging into new territory in mild traumatic brain injury or concussion detection, which has heretofore lacked objective diagnostics and monitoring tools.
One of the most challenging aspects of treating acute ischemic stroke (AIS) is getting the available treatments to the right patients in enough time to positively impact outcomes. Stroke treatment efficacy is very time dependent, and research suggests there is an association between earlier treatment and better outcomes. Brain cells start to die after only four minutes without oxygen, and 1.9 million neurons and 14 billion synapses are lost each minute during a typical large-vessel ischemic stroke. (See Exhibit 1.)
Exhibit 1
Ischemic Stroke Quantified
- Average number of neurons in the human forebrain: 22 billion
- Average duration of a typical large-vessel stroke: 10 hours (range 6–18 hours)
- During a typical large-vessel ischemic stroke a patient loses:
- 1.9 million neurons and 14 billion synapses per minute
- 120 million neurons and 830 billion synapses per hour
Source: Italo Linfante, MD, from a presentation at the 2010 International Symposium on Endovascular Therapy (ISET) meeting
Unfortunately, the vast majority of patients who experience a stroke do not receive a diagnosis within the time window that would qualify them for pharmacological or mechanical reperfusion therapies. (See "Stroke Devices: Hope Amid Headwinds" — Medtech Insight, September 2013.) But what if there was a treatment that could preserve the brain and expand the treatment window by slowing brain cell death and limiting hypoxic brain injury? Most people have heard of someone who drowned and was under cold water for a prolonged period of time but survived with brain function intact. This neuroprotective phenomenon has led to a great deal of interest in using therapeutic hypothermia in stroke patients as an adjunct to reperfusion therapy in an effort to save brain cells, extend the treatment window, and potentially expand the treatable population.
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