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

Abstract

The use of post-reperfusion cooling as a rescue treatment in patients with substantial ischemia at baseline might improve clinical outcome.

Intensive Care Management Following Endovascular Clot Retrieval for Acute Stroke: A Systematic Review of the Literature

“…4 As such, 16 clinical studies were included in this review. [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] The flow of studies and reasons for exclusion are shown in ►Fig. 1.…”

“…There were several small prospective case series describing specific interventions following ECR. 9,11,17 The results of the validity assessment are shown in Supplementary Table S1 (online only). The overall risk of bias amongst the included studies was high.…”

“…Hwang et al and Horn et al both reported small case series of patients with moderate to severe strokes (based on Alberta Stroke Program Early CT Score [ASPECTS] at baseline) from a proximal occlusion who received hypothermia (33)(34). 11,17 Despite positive results such studies can only be considered hypothesis testing. As such most guidelines do not recommend induced hypothermia.…”

Targeted temperature management for ischemic stroke

“…Among the neuroprotective strategies, TH has been attempted to evaluate the outcome benefits in experiments and clinical trials [4,9]. In a recent postreperfusion TH study, several patients (approximately 45%) had favorable outcomes based on the modified Rankin Scale 0, 1, 2 at 3 months despite low baseline alberta stroke pro-gram early CT score (ASPECTS) and large lesion volume ( > 80 mL) [34]. Recent EVT trials showed that EVT was useful for patients with a large core volume, and reperfusion rate was a predictor of good outcomes [35][36][37].…”

Primary neurocritical care involving therapeutic hypothermia for acute ischemic stroke patients with malignant infarct cores

“…Neurocritical care for patients with massive ischemic stroke has also improved, especially in terms of neuroprotection and the antiswelling effect of therapeutic hypothermia [4]. While the therapeutic benefits of hypothermia on functional outcomes need to be further validated in prospective trials [5], there is evidence that it can reduce cerebral edema, reduce hemorrhagic transformation and improve outcomes, especially in those with complete reperfusion [4,6]. These developments have possibly increased the number of patients eligible for reperfusion therapies, while potentially reducing the number of patients that show malignant progression [7].…”