Impact of immediate post-reperfusion cooling on outcome in patients with acute stroke and substantial ischemic changes

BackgroundIn patients with acute stroke and an extensive ischemic burden at baseline, the prognosis is usually poor despite timely reperfusion.ObjectiveTo overcome universally poor outcomes in such patients, by applying immediate ‘post-reperfusion cooling’ in order to reduce reperfusion-related comp...

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Published inJournal of neurointerventional surgery Vol. 9; no. 1; pp. 21 - 25
Main Authors Hwang, Yang-Ha, Jeon, Ji-Su, Kim, Yong-Won, Kang, Dong-Hun, Kim, Yong-Sun, Liebeskind, David S
Format Journal Article
LanguageEnglish
Published England BMJ Publishing Group LTD 01.01.2017
Subjects
Aged
Brain Ischemia - diagnostic imaging
Brain Ischemia - therapy
Cold Temperature
Cryotherapy - methods
Endovascular Procedures - methods
Female
Humans
Male
Middle Aged
Prognosis
Prospective Studies
Reperfusion - methods
Retrospective Studies
Stroke - diagnostic imaging
Stroke - therapy
Treatment Outcome
Intervention
MRI
Stroke
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Summary:BackgroundIn patients with acute stroke and an extensive ischemic burden at baseline, the prognosis is usually poor despite timely reperfusion.ObjectiveTo overcome universally poor outcomes in such patients, by applying immediate ‘post-reperfusion cooling’ in order to reduce reperfusion-related complications, and to describe the clinical and imaging characteristics.MethodsPatients having (1) an acute anterior large vessel occlusive stroke within 4.5 h since last known well, (2) Alberta Stroke Program Early CT Score (ASPECTS) ≤5 on baseline imaging, and (3) targeted temperature management with endovascular cooling after confirmed reperfusion were included in this study.ResultsEighteen patients (mean±SD age 59.5±10.9 years, median National Institutes of Health Stroke Scale score of 17, and median ASPECTS of 3) were analyzed. Median lesion volumes at baseline and after treatment were 130.2 and 110.6 mL, respectively. Median time from onset to the start of hypothermia and hypothermia duration were 213 min and 51 h, respectively. Favorable outcome (modified Rankin Scale ≤2) at 3 months was observed in 10 (55.6%) patients. Symptomatic intracranial hemorrhage, malignant brain edema, and pneumonia were observed in 2, 6, and 8 patients, respectively.ConclusionsThe use of post-reperfusion cooling as a rescue treatment in patients with substantial ischemia at baseline might improve clinical outcome.
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ISSN:1759-8478
1759-8486
DOI:10.1136/neurintsurg-2015-012233