Impact of immediate postrecanalization cooling on outcome in acute ischemic stroke patients with a large ischemic core: prospective cohort study

作者：Xuesong Bai, Xin Qu, Raul G. Nogueira, Wenhuo Chen, Hao Zhao, Wenbo Cao, Peng Gao, Bin Yang, Yabing Wang, Jian Chen, Yanfei Chen, Yuxin Wang, Shang Feng, Weitao Cheng, Yueqiao Xu, Meng Qi, Lidan Jiang, Wenjin Chen, Jie Lu, Qingfeng Ma, Ning Wang, Liqun Jiao · 发表于：International Journal of Surgery · 年份：2024 · DOI：10.1097/js9.0000000000001127 · 被引用次数：9 · 研究领域：Thermal Regulation in Medicine、Acute Ischemic Stroke Management、Climate Change and Health Impacts

BACKGROUND: Patients with large acute ischemic strokes (AIS) often have a poor prognosis despite successful recanalization due to multiple factors including reperfusion injury. The authors aim to describe our preliminary experience of endovascular cooling in patients with a large AIS after recanalization. METHODS: From January 2021 to July 2022, AIS patients presenting with large infarcts (defined as ASPECTS ≤5 on noncontrast CT or ischemic core ≥50 ml on CT perfusion) who achieved successful recanalization after endovascular treatment were analyzed in a prospective registry. Patients were divided into targeted temperature management (TTM) and non-TTM group. Patients in the TTM group received systemic cooling with a targeted core temperature of 33° for at least 48 h. The primary outcome is 90-day favorable outcome [modified Rankin Scale (mRS) 0-2]. The secondary outcomes are 90-day good outcome (mRS 0-3), mortality, intracranial hemorrhage and malignant cerebral edema within 7 days or at discharge. RESULTS: Forty-four AIS patients were recruited (15 cases in the TTM group and 29 cases in the non-TTM group). The median Alberta Stroke Program Early CT Score (ASPECTS) was 3 (2-5). The median time for hypothermia duration was 84 (71.5-147.6) h. The TTM group had a numerically higher proportion of 90-day favorable outcomes than the non-TTM group (46.7 vs. 27.6%, P=0.210), and no significant difference were found regarding secondary outcomes (all P>0.05). The TTM group had a numeri...