Feasibility of endovascular and surface cooling strategies in acute stroke

Ovesen, Christian; Brizzi, Marco; Pott, Frank Christian; Thorsen-Meyer, Hans-Christian; Karlsson, Torbjörn; Ersson, Anders; Christensen, Hanne; Norrlin, A.; Meden, Per; Krieger, Derk; Petersson, Jesper

doi:10.1111/ane.12059

Cited by 38 publications

(33 citation statements)

References 23 publications

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“…Intra-arterial infusion cooling can easily be combined with other endovascular interventions and has the advantage of cooling the highest risk tissue first. In spite of being capable of reaching the target temperature faster, endovascular cooling is invasive, non-removable and may cause significant complications (Ovesen et al , 2012). …”

Section: Hypothermiamentioning

confidence: 99%

Non-pharmaceutical therapies for stroke: Mechanisms and clinical implications

Chen

Luo

et al. 2014

Progress in Neurobiology

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Stroke is deemed a worldwide leading cause of neurological disability and death, however, there is currently no promising pharmacotherapy for acute ischemic stroke aside from intravenous or intra-arterial thrombolysis. Yet because of the narrow therapeutic time window involved, thrombolytic application is very restricted in clinical settings. Accumulating data suggest that non-pharmaceutical therapies for stroke might provide new opportunities for stroke treatment. Here we review recent research progress in the mechanisms and clinical implications of non-pharmaceutical therapies, mainly including neuroprotective approaches such as hypothermia, ischemic/hypoxic conditioning, acupuncture, medical gases, transcranial laser therapy, etc. In addition, we briefly summarize mechanical endovascular recanalization devices and recovery devices for the treatment of the chronic phase of stroke and discuss the relative merits of these devices.

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Section: Hypothermiamentioning

confidence: 99%

Non-pharmaceutical therapies for stroke: Mechanisms and clinical implications

Chen

Luo

et al. 2014

Progress in Neurobiology

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“…[12][13][14] The mortality rate of the hypothermia group was 0% in our trial, 28% in the COOL AID II, 21% in the ICTuS-L, and 12% in the COOLAID Oresund trial, but there were some differences in stroke severity (pretreatment mean NIHSS being 12, 15, 14, and 8 [median], respectively). Our pneumonia rate (39%) is comparable with that of the ICTuS-L (50%) and …”

Section: Discussionmentioning

confidence: 56%

“…The median time from symptom onset to initiation of hypothermia (n=18) was 6 hours (range, 4.5-6.5). Sixteen patients of the hypothermia group reached <35.5°C in a median time of 4.5 hours (3-11), spent 10.5 hours (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17) at 34.5°C to 35.5°C, and 16.8 hours (3-21) at <36.0°C. Patients were rewarmed by increasing the target temperature for duration of 7 hours (2-9).…”

Section: Outcome: Feasibilitymentioning

confidence: 99%

Mild Hypothermia After Intravenous Thrombolysis in Patients With Acute Stroke

Piironen

Tiainen

Mustanoja

et al. 2014

Stroke

104

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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.)

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“…Favorable functional outcome was assessed with the mRS at one-to three-months in five studies, and defined as ≤1 in the studies by Bi et al (21) and Hemmen et al (23) and ≤2 in the studies by Piironen et al (20), Ovesen et al (24) and De Georgia et al (22). The analysis included 227 patients and showed no statistically significant difference in favorable functional outcome between patients treated with induction of hypothermia and controls (RR: 0·92, 95% CI: 0·63-1·33), with no sign of heterogeneity (I 2 :0%) (Fig.…”

Section: Pico3: In Patients With Acute Ischemic Stroke Does Inductiomentioning

confidence: 99%

“…Mortality was assessed at one-to three-months in all six trials (20)(21)(22)(23)(24)(25). The analysis included 252 patients, and there was no statistically significant difference in mortality between patients receiving hypothermia and controls (RR: 1·20, 95% CI: 0·65-2·22), with no sign of heterogeneity (I 2 : 0%) (Fig.…”

Section: Pico3: In Patients With Acute Ischemic Stroke Does Inductiomentioning

confidence: 99%

European Stroke Organisation (ESO) Guidelines for the Management of Temperature in Patients with Acute Ischemic Stroke

Ntaios

Dziedzic

Michel

et al. 2015

International Journal of Stroke

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Background Hyperthermia is a frequent complication in patients with acute ischemic stroke. On the other hand, therapeutically induced hypothermia has shown promising potential in animal models of focal cerebral ischemia. This Guideline Document presents the European Stroke Organisation guidelines for the management of temperature in patients with acute ischemic stroke. Methods A multidisciplinary group identified related questions and developed its recommendations based on evidence from randomized controlled trials elaborating the Grading of Recommendations Assessment, Development, and Evaluation approach. This Guideline Document was reviewed within the European Stroke Organisation and externally and was approved by the European Stroke Organisation Guidelines Committee and the European Stroke Organisation Executive Committee. Results We found low‐quality evidence, and therefore, we cannot make any recommendation for treating hyperthermia as a means to improve functional outcome and/or survival in patients with acute ischemic stroke and hyperthermia; moderate evidence to suggest against routine prevention of hyperthermia with antipyretics as a means to improve functional outcome and/or survival in patients with acute ischemic stroke and normothermia; very low‐quality evidence to suggest against routine induction of hypothermia as a means to improve functional outcome and/or survival in patients with acute ischemic stroke. Conclusions The currently available data about the management of temperature in patients with acute ischemic stroke are limited, and the strengths of the recommendations are therefore weak. We call for new randomized controlled trials as well as recruitment of eligible patients to ongoing randomized controlled trials to allow for better‐informed recommendations in the future.

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Feasibility of endovascular and surface cooling strategies in acute stroke

Abstract: Therapeutic hypothermia with general anaesthesia is feasible in stroke patients. We noticed increased rates of pneumonia, while the length of hospital stay remained comparable. The endovascular cooling strategy provides a faster induction period than surface cooling.

Cited by 38 publications

References 23 publications

Non-pharmaceutical therapies for stroke: Mechanisms and clinical implications

Non-pharmaceutical therapies for stroke: Mechanisms and clinical implications

Mild Hypothermia After Intravenous Thrombolysis in Patients With Acute Stroke

European Stroke Organisation (ESO) Guidelines for the Management of Temperature in Patients with Acute Ischemic Stroke

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