Mild Hypothermia After Intravenous Thrombolysis in Patients With Acute Stroke

Abstract

Background and Purpose-Hypothermia improves outcome in resuscitated patients and newborns with hypoxic brain injury.We studied the safety and feasibility of mild hypothermia in awake patients with stroke after intravenous thrombolysis. Methods-Patients were randomized 1:1 to mild hypothermia (35°C) or to standard stroke unit care within 6 hours of symptom onset. Hypothermia was induced with a surface-cooling device and cold saline infusions. Active cooling was restrained gradually after 12 hours at <35.5°C. The primary outcome measure was the number of patients with <36°C body temperature for >80% of the 12-hour cooling period. Results-We included 36 patients with a median of National Institutes of Health Stroke Scale score of 9 one hour after thrombolysis. Fifteen of 18 (83%) patients achieved the primary end point. Sixteen (89%) patients reached <35.5°C in a median time of 10 hours (range, 7-16 hours) from symptom onset, spent 10.5 hours (1-17 hours) in hypothermia, and were back to normothermia in 23 hours (15-29 hours). Few serious adverse events were more common in the hypothermia group. At 3 months, 7 patients (39%) in both groups had good outcome (modified Ranking Scale, 0-2), whereas poor outcome (modified Ranking Scale, 4-6) was twice as common in the normothermia group (44% versus 22%). Conclusions-Mild hypothermia with a surface-cooling device in an acute stroke unit is safe and feasible in thrombolyzed, spontaneously breathing patients with stroke, despite the adverse events. Clinical Trial Registration-URL: http://www. clinicaltrials.gov. Unique identifier: NCT00987922.(Stroke. 2014;45:486-491.)

Endovascular Cooling Catheter for Selective Brain Hypothermia: An Animal Feasibility Study of Cooling Performance

“…2 Recently, the feasibility and safety of TH in patients with acute ischemic stroke was proved in controlled studies, [3][4][5][6] and 2 multicenter, randomized clinical trials (EuroHYP-1 and ICTuS 2/3) 7, 8 are currently underway to study its efficacy.…”

Combined Selective Cerebral Hypothermia and Mechanical Artery Recanalization in Acute Ischemic Stroke: In Vitro Study of Cooling Performance

“…[1][2][3][4] Neuroprotection provided by TH affects multiple aspects of brain physiology during all stages of ischemia (eg, excitotoxicity, apoptosis, inflammation, free radical production, blood flow, metabolism, and blood-brain barrier integrity). 5 Recently, the feasibility and safety of TH in patients with acute ischemic stroke was proved in controlled studies, [6][7][8][9] and 2 multicenter, randomized clinical trials (European Stroke Research Network for Hypothermia-1 and Intravenous Thrombolysis plus Hypothermia for Acute Treatment of Ischemic Stroke 2/3) 10,11 are currently underway to study its efficacy. Until now, TH in patients with acute stroke has been applied only systematically by surface cooling, intravenous cooling, or cold saline infusions.…”

Neuroprotective strategies for acute ischemic stroke: recent progress and future perspectives

“…There have been several advances in the field of neuroprotective strategies (Table 1) [16,17,[22][23][24][25][26][27][28][29][30][31][32][33][34][35][36].…”

“…NA-1 Postsynaptic density-95 protein inhibition to block NMDA-mediated excitotoxic signaling P re-interventional treatment of NA-1 prevented iatrogenic stroke (ENACT trial) [34]. T he ESPACE-NA-1 (NCT02930018) and FRONTIER (NCT02315443) trials are ongoing.…”