<ol>
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B. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Death+by+design:+apoptosis,+necrosis+and+autophagy.">Death by design: apoptosis, necrosis and autophagy.</a> Current Opinion in Cell Biology. 16, 663-669 (2004).</li><li>Kirino, T. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Delayed+neuronal+death+in+the+gerbil+hippocampus+following+ischemia.">Delayed neuronal death in the gerbil hippocampus following ischemia.</a> Brain Research. 239, 57-69 (1982).</li><li>Yager, J. Y., Brucklacher, R. M., Vannucci, R. C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Cerebral+energy+metabolism+during+hypoxia-ischemia+and+early+recovery+in+immature+rats.">Cerebral energy metabolism during hypoxia-ischemia and early recovery in immature rats.</a> The American Journal of Physiology. 262, 672-677 (1992).</li><li>Sugawara, T., Fujimura, M., Morita-Fujimura, Y., Kawase, M., Chan, P. H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Mitochondrial+release+of+cytochrome+c+corresponds+to+the+selective+vulnerability+of+hippocampal+CA1+neurons+in+rats+after+transient+global+cerebral+ischemia.">Mitochondrial release of cytochrome c corresponds to the selective vulnerability of hippocampal CA1 neurons in rats after transient global cerebral ischemia.</a> J. Neurosci. 19, RC39 (1999).</li><li>Nishino, H., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Pathophysiological+process+after+transient+ischemia+of+the+middle+cerebral+artery+in+the+rat.">Pathophysiological process after transient ischemia of the middle cerebral artery in the rat.</a> Brain Research Bulletin. 35, 51-56 (1994).</li><li>Ross, D. T., Ebner, F. F. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Thalamic+retrograde+degeneration+following+cortical+injury:+an+excitotoxic+process.">Thalamic retrograde degeneration following cortical injury: an excitotoxic process.</a> Neuroscience. 35, 525-550 (1990).</li><li>Soriano, M. A., Ferrer, I., Rodriguez-Farre, E., Planas, A. 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The authors have no financial conflicts of interest.

The model described here produces an ischemic insult to the brain that can occur as a result of cardiac arrest and resuscitation, providing an injury similar to that found in humans. This method for producing global brain ischemia is one of multiple protocols. We utilize this protocol foremost for its comparably low mortality rate, rapid recovery, and reproducible results. The cardiac arrest/resuscitation model is arguably the most clinically relevant model, however technically the most difficult to constantly rep...

Brain damage as a consequence of cardiac arrest and stroke is a leading cause of death and long-term disability. While cardiopulmonary resuscitation for victims of cardiac arrest succeeds in restoring spontaneous circulation in about 70,000 patients per year in the US 7,8 at least 60% of these patients subsequently die in the hospital as a result of extensive brain damage and only 3-10% of resuscitated patients can resume their former lifestyles 9,10 . Clearly, understanding the mechanisms that lead to brain damage following global brain ischemia and designing therapeutic interventions to minimize neurologic trauma is of critical importance.
Brain ischemia can be modeled utilizing multiple methods. Most commonly, brain ischemia is produced in the rodent by occluding a major blood vessel in the brain, the middle cerebral artery, thus producing a focal ischemic stroke 11,12 . While clinically important, focal brain ischemia is not an accurate method to study brain damage produced by cardiac arrest/resuscitation. To model this clinical paradigm the entire brain must be made ischemic followed by reintroduction of blood flow. To closely mimic this clinical presentation, investigators experimentally induce cardiac arrest followed by resuscitation with CPR and defibrillation 13,14 . This model is clinically relevant, however unpredictable resuscitation times can increase variability and may make data analysis difficult to interpret. Additionally, this model is associated with a high mortality rate, further increasing animal number necessary to test a hypothesis. Investigating the cerebral response to global ischemia and/or reperfusion in a more reproducible, consistent, and survivable insult may be preferred.
Global ischemia can be induced in the brain while preserving some blood flow systemically. This reduces mortality, while allowing investigation of the mechanisms of tissue damage in the brain 2. To produce global brain ischemia, it is necessary to interrupt or greatly limit flow in all four vessels that supply the brain, the internal carotid arteries and vertebral arteries. These vessels supply the brain with blood flow through a vascular structure called the Circle of Willis, which forms an anastomotic loop. This vascular architecture allows the brain to retain perfusion in the event of proximal vascular occlusion. Therefore, to induce complete ischemia of the brain, blood flow through all contributory vessels must occur. Carotid artery occlusion can be accomplished using a minimally invasive ventral neck cut-down and application of aneurism clips for a desired period. Interruption of blood flow via the vertebral arteries can be difficult, as they are incased in the transverse foramina of the vertebral column. Investigators have addressed this by electrocauterizing the vertebral arteries 24-48 hr prior to carotid occlusion and brain ischemia (4VO model) 15. In contrast to this approach, Smith, et al. developed a method of inducing global brain ischemia by reducing mean arterial blood pressure (MAP) systemically to 40 mmHg to reduce perfusion through the vertebral arteries to a point where blood flow is lost or greatly reduced 2. When coupled with carotid occlusion, this method produces ischemia throughout the forebrain, resulting in a pattern of brain damage that closely mimics that of cardiac arrest survivors. In a further refinement of this method, the model we present here requires tight MAP regulation at 30 mmHg &plusmn; 1mHg during the entire 8 min of ischemia. We found this alteration improves the reproducibility of brain damage induced by this model while preserving the low mortality rate of the original technique designed by Smith et al.
The precise phenotype of cell death and overall extent of tissue damage caused by the model presented here are directly dependent on ischemic duration 16. Following 8 min of ischemia, CA1 neurons exhibit delayed cell death, suggesting that there is a temporal window for therapeutic intervention during the reperfusion phase 15,17 . At the onset of reperfusion, neurons quickly regain function and no immediate cell death is detectable 18. However this insult causes induction of cell death cascades (apoptosis) that culminate in release of apoptogenic proteins from mitochondria, including cytochrome c, between 4-6 hr of reperfusion 3,19. Between 6 and 24 hr of reperfusion, neurons of the CA1 hippocampus have committed to cell demise, and the apoptotic cell death program is executed 19. It should be noted that cell death phenotype responsible for ischemic injury is highly controversial. Early studies have suggested necrosis is the primary cell death phenotype 20,21 , while other others report apoptosis as the principal mechanism 22,23 . In total, current evidence suggest that cells die of a spectrum of cell death phenotypes ranging from classic apoptosis to necrosis. The specific mode of cell death is dependent on many factors, with the degree of contribution of each phenotype depending on the severity of the insult, amongst other factors 24,25. By 24 hr of reperfusion, dying cells possess pyknotic nuclei, condensed cytosol with clear evidence of aggregated cellular contents, and loss of functional mitochondrial morphology. Dead cells are further broken down, engulfed by immune cells such as macrophages and/or microglia, and cleared from the CA1 hippocampal region. By 4-7 days of reperfusion, dead cells are removed, and all that remains are inflammatory cells and activated glial cells 17,26 . Therefore, 7 days of reperfusion represents an optimal time where CA1 hippocampal neuronal death can be quantified using simple, non-specific cell stains including Cresyl violet or hemotoxylin-eosin and counted based on morphologic inclusion criteria. Cells remaining at this late reperfusion interval can be counted as surviving cells, thus providing an index of brain damage.
If this model is to be utilized to test therapeutic interventions, it is suggested that the experimental design follow STAIR criteria (Stroke Therapy Academic Industry Roundtable) 27. These guidelines should be followed when designing and conducting a study, however are not discussed here.

<table border="1">
 <tbody>
 <tr>
 <td></td>
 <td></td>
 <td></td>
 <td>Material Name</td>
 </tr>
 <tr>
 <td>5-0 VICRYL suture, reverse cutting </td>
 <td>Ethicon</td>
 <td>J391H</td>
 <td></td>
 </tr>
 <tr>
 <td>Scalpel, No.10</td>
 <td>Swann-Morton</td>
 <td>6601</td>
 <td></td>
 </tr>
 <tr>
 <td>Gauze Sponges</td>
 <td>Fisher</td>
 <td>22-362-178</td>
 <td></td>
 </tr>
 <tr>
 <td>18G x 1 &frac12; in needle</td>
 <td>BD</td>
 <td>305201</td>
 <td></td>
 </tr>
 <tr>
 <td>23G x 1 in needle</td>
 <td>BD</td>
 <td>305145</td>
 <td></td>
 </tr>
 <tr>
 <td>26 G x 3/8 in needle</td>
 <td>BD</td>
 <td>305110</td>
 <td></td>
 </tr>
 <tr>
 <td>18 G x 1 &frac14; catheter</td>
 <td>EXEL</td>
 <td>26735</td>
 <td></td>
 </tr>
 <tr>
 <td>1 ml syringe</td>
 <td>BD</td>
 <td>309659</td>
 <td></td>
 </tr>
 <tr>
 <td>10 ml syringe</td>
 <td>BD</td>
 <td>309604</td>
 <td></td>
 </tr>
 <tr>
 <td>60 ml syringe</td>
 <td>BD</td>
 <td>309653</td>
 <td></td>
 </tr>
 <tr>
 <td>Surgilube</td>
 <td>Henry Schein</td>
 <td>1152666</td>
 <td></td>
 </tr>
 <tr>
 <td>.9% Saline, plastic IV bag</td>
 <td>Henry Schein</td>
 <td>1537468</td>
 <td></td>
 </tr>
 <tr>
 <td>Suture 3-0 Silk</td>
 <td>Henry Schein</td>
 <td>1007842</td>
 <td></td>
 </tr>
 <tr>
 <td>Puralube Ophthalmic Ointment</td>
 <td>Henry Schein</td>
 <td>3390017</td>
 <td></td>
 </tr>
 <tr>
 <td>Betadine</td>
 <td>Henry Schein</td>
 <td>6903564</td>
 <td></td>
 </tr>
 <tr>
 <td>Sterile Towel Drape</td>
 <td>Moore Medical</td>
 <td>14170</td>
 <td></td>
 </tr>
 <tr>
 <td>Polyethylene Tubing, 50</td>
 <td>Intramedic</td>
 <td>427411</td>
 <td></td>
 </tr>
 <tr>
 <td>Stopcock, 3 way</td>
 <td>Smiths medical</td>
 <td>MX9311L</td>
 <td></td>
 </tr>
 <tr>
 <td></td>
 <td></td>
 <td></td>
 <td>Drug Name</td>
 </tr>
 <tr>
 <td>AERRANE (isoflurane)</td>
 <td>Henry Schein</td>
 <td>2091966</td>
 <td></td>
 </tr>
 <tr>
 <td>Mapap Liquid (Tylenol)</td>
 <td>Major Pharmaceuticals</td>
 <td>1556</td>
 <td></td>
 </tr>
 <tr>
 <td>Kedavet (ketamine)</td>
 <td>Ketathesia Butney</td>
 <td>NDC 50989-996-06</td>
 <td></td>
 </tr>
 <tr>
 <td>Butorphic (butorphanol)</td>
 <td>Lloyd Labs</td>
 <td>4881</td>
 <td></td>
 </tr>
 <tr>
 <td>Heparin</td>
 <td>APP Pharmaceuticals</td>
 <td>504011</td>
 <td></td>
 </tr>
 <tr>
 <td></td>
 <td></td>
 <td></td>
 <td>Chemical Name </td>
 </tr>
 <tr>
 <td>Paraformaldehyde prills</td>
 <td>Elecron Microscopy Sci.</td>
 <td>19202</td>
 <td></td>
 </tr>
 <tr>
 <td>2-methylbutane</td>
 <td>Sigma</td>
 <td>270342</td>
 <td></td>
 </tr>
 <tr>
 <td>Cresyl Violet Acetate</td>
 <td>Sigma</td>
 <td>C5042</td>
 <td></td>
 </tr>
 <tr>
 <td>Sucrose</td>
 <td>Sigma</td>
 <td>S9378</td>
 <td></td>
 </tr>
 <tr>
 <td></td>
 <td></td>
 <td></td>
 <td>Software</td>
 </tr>
 <tr>
 <td>ImageJ</td>
 <td>NIH</td>
 <td></td>
 <td></td>
 </tr>
 </tbody>
</table>

2-vessel occlusion/hypotension: a rat model of global brain ischemia

Cardiac arrest followed by resuscitation often results in dramatic brain damage caused by ischemia and subsequent reperfusion of the brain. Global brain ischemia produces damage to specific brain regions shown to be highly sensitive to ischemia 1. Hippocampal neurons have higher sensitivity to ischemic insults compared to other cell populations, and specifically, the CA1 region of the hippocampus is particularly vulnerable to ischemia/reperfusion 2.
The design of therapeutic interventions, or study of mechanisms involved in cerebral damage, requires a model that produces damage similar to the clinical condition and in a reproducible manner. Bilateral carotid vessel occlusion with hypotension (2VOH) is a model that produces reversible forebrain ischemia, emulating the cerebral events that can occur during cardiac arrest and resuscitation. We describe a model modified from Smith et al. (1984) 2, as first presented in its current form in Sanderson, et al. (2008) 3, which produces reproducible injury to selectively vulnerable brain regions 3-6. The reliability of this model is dictated by precise control of systemic blood pressure during applied hypotension, the duration of ischemia, close temperature control, a specific anesthesia regimen, and diligent post-operative care. An 8-minute ischemic insult produces cell death of CA1 hippocampal neurons that progresses over the course of 6 to 24 hr of reperfusion, while less vulnerable brain regions are spared. This progressive cell death is easily quantified after 7-14 days of reperfusion, as a near complete loss of CA1 neurons is evident at this time.
In addition to this brain injury model, we present a method for CA1 damage quantification using a simple, yet thorough, methodology. Importantly, quantification can be accomplished using a simple camera-mounted microscope, and a free ImageJ (NIH) software plugin, obviating the need for cost-prohibitive stereology software programs and a motorized microscopic stage for damage assessment.

The 2VOH model of global brain ischemia/reperfusion causes neuronal death in the CA1 region of the hippocampus. Figure 2 represents the injury produced by 8 min of global brain ischemia, processed 14 days after reperfusion. Figures 2A and 2B compare the hippocampi from sham and post-ischemic brains, stained with Cresyl violet. Figure 2A shows a hippocampus from a sham-operated rat which exhibits normal morphology, including an intact CA1. Figure ...

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2-Vessel Occlusion/Hypotension: A Rat Model of Global Brain Ischemia

Bilateral carotid occlusion coupled with systemic hypotension produces global brain ischemia in the rat, resulting in damage to the hippocampus with reproducible severity. Animal subjects are impaired with predictable patterns of brain damage, they recover expediently, and mortality rates are comparatively low.

Cardiac arrest followed by resuscitation often results in dramatic brain damage caused by ischemia and subsequent reperfusion of the brain. Global brain ...

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19.8K Views.  Wayne State University School of Medicine. Bilateral carotid occlusion coupled with systemic hypotension produces global brain ischemia in the rat, resulting in damage to the hippocampus with reproducible severity. Animal subjects are impaired with predictable patterns of brain damage, they recover expediently, and mortality rates are comparatively low.