Article Text

PDF
Case series
Impact of immediate post-reperfusion cooling on outcome in patients with acute stroke and substantial ischemic changes
  1. Yang-Ha Hwang1,2,
  2. Ji-Su Jeon1,
  3. Yong-Won Kim1,2,3,
  4. Dong-Hun Kang2,3,4,
  5. Yong-Sun Kim2,3,
  6. David S Liebeskind5
  1. 1Department of Neurology, Kyungpook National University School of Medicine and Hospital, Daegu, South Korea
  2. 2Cerebrovascular Center, Kyungpook National University School of Medicine and Hospital, Daegu, South
  3. 3Department of Radiology,  Kyungpook National University School of Medicine and Hospital, Daegu, South Korea
  4. 4Department of Neurosurgery, Kyungpook National University School of Medicine and Hospital, Daegu, South Korea
  5. 5UCLA Stroke Center, University of California, Los Angeles, California, USA
  1. Correspondence to Dr David S Liebeskind, UCLA Department of Neurology, 635 Charles E Young Drive South, Suite 225 Los Angeles, CA 90095-7334, USA; davidliebeskind{at}yahoo.com

Abstract

Background In patients with acute stroke and an extensive ischemic burden at baseline, the prognosis is usually poor despite timely reperfusion.

Objective To 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.

Methods Patients 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.

Results Eighteen 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.

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

  • Stroke
  • Intervention
  • MRI

Statistics from Altmetric.com

Footnotes

  • Twitter Follow Yang-Ha Hwang at @yangha73

  • Contributors Study concept and design: Y-HH and DSL. Analysis and interpretation of data: Y-HH, J-SJ, Y-WK, D-HK. Drafting of the manuscript: Y-HH. Critical revision of the manuscript for important intellectual content: Y-SK, DSL.

  • Competing interests None declared.

  • Patient consent No.

  • Ethics approval Kyungpook National University Hospital.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Not applicable.

Request permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.