title: Local mild hypothermia with thrombolysis for acute ischemic stroke within a 6-h window.
abstract: OBJECTIVE
  To determine the safety and efficacy of combined local mild hypothermia and IV rtPA in treating acute ischemic stroke (AIS) patients with MRI perfusion- and diffusion-weighted imaging (PWI/DWI) mismatch within a 6-h stroke window.
  
  
  METHODS
  AIS patients within 6 h of a minimum 20% PWI/DWI MRI mismatch were randomly assigned to 3 groups: local mild hypothermia with IV rtPA (Group A); IV rtPA (Group B); or conventional anti-platelet aggregation (Group C). Mortality and National Institutes of Health Stroke Scale (NIHSS) and the modified Rankin Scale (mRS) score and Barthel Index (BI) were used in evaluation.
  
  
  RESULTS
  There were significant differences in NIHSS 24 h after treatment among the three groups (P<0.001). Based on mRS and BI, more patients in Groups A and B showed favorable outcomes than patients in Group C (P=0.017 and P=0.009, respectively); however, there were no significant efficacy differences between Groups A and B. The incidence of symptomatic ICH and the mortality rates within 90 days in the 3 groups were similar. In addition, there were no significant differences in NIHSS improvement at 24 h and favorable outcomes 90 days after IV rtPA treatment between patients within 3 h and 3-6 h from symptom onset.
  
  
  CONCLUSIONS
  There was no benefit of combined local hypothermia/IV rtPA treatment compared to IV rtPA alone. PWI/DWI mismatching on MRI can be a selection criteria for IV rtPA treatment within a 6-h window.
authors: Department of Neurology, The First Affiliated Hospital of Xiamen University, 55 Zhenhai Road, Xiamen 361003, China.
authors: Min
authors: M
authors: Bi
authors: Qilin
authors: Q
authors: Ma
authors: Shiyang
authors: S
authors: Zhang
authors: Jianpeng
authors: J
authors: Li
authors: Yidan
authors: Y
authors: Zhang
authors: Longting
authors: L
authors: Lin
authors: Suijun
authors: S
authors: Tong
authors: Desheng
authors: D
authors: Wang
mesh_terms: D000368:Aged; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D006801:Humans; D007036:Hypothermia, Induced / Q000009:adverse effects; D007091:Image Processing, Computer-Assisted; D018810:Magnetic Resonance Angiography; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D020521:Stroke / Q000188:drug therapy / Q000401:mortality / Q000628:therapy*; D015912:Thrombolytic Therapy / Q000009:adverse effects; D010959:Tissue Plasminogen Activator / Q000009:adverse effects / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D010975:Platelet Aggregation Inhibitors; D010959:Tissue Plasminogen Activator