Selective intraarterial hypothermia combined with mechanical thrombectomy for acute cerebral infarction based on microcatheter technology: A single-center, randomized, single-blind controlled study

Abstract

ObjectiveTo investigate the safety and efficacy of selective intraarterial hypothermia combined with mechanical thrombectomy in the treatment of acute cerebral infarction based on microcatheter technology.MethodsA total of 142 patients with anterior circulation large vessel occlusion were randomly assigned to the hypothermic treatment group (test group) and the conventional treatment group (control group). National Institutes of Health Stroke Scale (NIHSS) scores, postoperative infarct volume, the 90-day good prognosis rate (modified Rankin Scale (mRS) score ≤ 2 points), and the mortality rate of the two groups were compared and analyzed. Blood specimens were collected from patients before and after treatment. Serum levels of superoxide dismutase (SOD), malondialdehyde (MDA), interleukin-6 (IL-6), IL-10, and RNA-binding motif protein 3 (RBM3) were measured.ResultsThe 7-day postoperative cerebral infarct volume [(63.7 ± 22.1) ml vs. (88.5 ± 20.8) ml] and NIHSS scores at postoperative Days 1, 7, and 14 [(6.8 ± 3.8) points vs. (8.2 ± 3.5) points; (2.6 ± 1.6) points vs. (4.0 ± 1.8) points; (2.0 ± 1.2) points vs. (3.5 ± 2.1) points] in the test group were significantly lower than those in the control group. The good prognosis rate at 90 days postoperatively (54.9 vs. 35.2%, P = 0.018) was significantly higher in the test group than in the control group. The 90-day mortality rate was not statistically significant (7.0 vs. 8.5%, P = 0.754). Immediately after surgery and 1 day after surgery, SOD, IL-10, and RBM3 levels in the test group were relatively higher than those in the control group, and the differences were statistically significant. Immediately after surgery and 1 day after surgery, MDA and IL-6 levels in the test group were relatively reduced compared with those in the control group, and the differences were statistically significant (P < 0.05). In the test group, RBM3 was positively correlated with SOD and IL-10.ConclusionMechanical thrombectomy combined with intraarterial cold saline perfusion is a safe and effective measure for the treatment of acute cerebral infarction. Postoperative NIHSS scores and infarct volumes were significantly improved with this strategy compared with simple mechanical thrombectomy, and the 90-day good prognosis rate was improved. The mechanism by which this treatment exerts its cerebral protective effect may be by inhibiting the transformation of the ischaemic penumbra of the infarct core area, scavenging some oxygen free radicals, reducing inflammatory injury to cells after acute infarction and ischaemia–reperfusion, and promoting RBM3 production in cells.

Trends and hotspots of the neuroprotection of hypothermia treatment: A bibliometric and visualized analysis of research from 1992 to 2023

“…Recent clinical studies all use saline as the cooling solution for a short cooling period because long‐term continuous infusion of saline can increase the burden on heart function and reduce the hematocrit. 30 , 31 In principle, while maintaining core temperature, the longer the selective low‐temperature time for brain tissue, the better neuroprotection could be obtained. Thus, drawn inspiration from extracorporeal membrane oxygenation technology, intra‐artery cooling autologous blood perfusion technology proposed by Ji xunming group seems to be the best way to resolve all existing concerns.…”

Targeted Temperature Management for Patients with Acute Ischemic Stroke: A Literature Review

“…The most frequent initiation time, as indicated by 39.1% of the studies, occurred less than 6 h after the stroke [9][10][11]14,17,18,27,31,34], which was followed by the initiation time of 12 h after the stroke in 17.4% of the studies [13,26,28,33]. The remaining 43.5% of studies demonstrated variable timeframes for the initiation of TTM ranging from 4.5 to 5 h [19,21] or to 60.0 h [12] (Table 1).…”

“…There was a diverse distribution of study designs in our analysis (Tables 1 and 2). Among the identified studies, 13 were randomized controlled trials (RCTs) [9][10][11][12][13][14][15][16][17][18][19][20][21], 12 were prospective non-randomized studies [8,[22][23][24][25][26][27][28][29][30][31][32], 2 were case-control studies [33,34], 1 was a prospective cohort study [35], and 1 was a prospective observational study [36].…”

“…A total of 40.0% of the IA-SCI studies initiated TTM 6 h after the stroke [18,31], 20.0% reported 3 h after the stroke [29], 20.0% began TTM 8 h after the stroke [30], and 20.0% applied TTM 24 h after the stroke [19] (Table 2).…”

“…The longest duration of TTM reported was 4 h [29]. Other studies reported cooling times of 35 min [19] and 15 min [31], with two remaining studies utilizing a cold saline perfusion duration of 10 min [18,30].…”