title: Therapeutic hypothermia after recanalization in patients with acute ischemic stroke.
abstract: OBJECTIVE
  Therapeutic hypothermia improves outcomes in experimental stroke models, especially after ischemia-reperfusion injury. We investigated the clinical and radiological effects of therapeutic hypothermia in acute ischemic stroke patients after recanalization.
  
  
  METHODS
  A prospective cohort study at 2 stroke centers was performed. We enrolled patients with acute ischemic stroke in the anterior circulation with an initial National Institutes of Health Stroke Scale≥10 who had successful recanalization (≥thrombolysis in cerebral ischemia, 2b). Patients at center A underwent a mild hypothermia (34.5°C) protocol, which included mechanical ventilation, and 48-hour hypothermia and 48-hour rewarming. Patients at center B were treated according to the guidelines without hypothermia. Cerebral edema, hemorrhagic transformation, good outcome (3-month modified Rankin Scale, ≤2), mortality, and safety profiles were compared. Potential variables at baseline and during the therapy were analyzed to evaluate for independent predictors of good outcome.
  
  
  RESULTS
  The hypothermia group (n=39) had less cerebral edema (P=0.001), hemorrhagic transformation (P=0.016), and better outcome (P=0.017) compared with the normothermia group (n=36). Mortality, hemicraniectomy rate, and medical complications were not statistically different. After adjustment for potential confounders, therapeutic hypothermia (odds ratio, 3.0; 95% confidence interval, 1.0-8.9; P=0.047) and distal occlusion (odds ratio, 7.3; 95% confidence interval; 1.3-40.3; P=0.022) were the independent predictors for good outcome. Absence of cerebral edema (odds ratio, 5.4; 95% confidence interval, 1.6-18.2; P=0.006) and no medical complications (odds ratio, 9.3; 95% confidence interval, 2.2-39.9; P=0.003) were also independent predictors for good outcome during the therapy.
  
  
  CONCLUSIONS
  In patients with ischemic stroke, after successful recanalization, therapeutic hypothermia may reduce risk of cerebral edema and hemorrhagic transformation, and lead to improved clinical outcomes.
authors.affiliation: From the Department of Neurology, Ajou University School of Medicine, Suwon, South Korea (J.M.H., J.S.L.); Department of Neurology, Chungnam National College of Medicine, Daejon, South Korea (H.-J.S., H.-S.J.); and Department of Neurology and Neurosurgery, University of Texas Health Science Center at Houston (J.M.H., H.A.C., K.L.).
authors.forename: Ji Man
authors.initials: JM
authors.lastname: Hong
authors.forename: Jin Soo
authors.initials: JS
authors.lastname: Lee
authors.forename: Hee-Jung
authors.initials: HJ
authors.lastname: Song
authors.forename: Hye Seon
authors.initials: HS
authors.lastname: Jeong
authors.forename: Hae-Sun
authors.initials: HS
authors.lastname: Jung
authors.forename: Huimahn Alex
authors.initials: HA
authors.lastname: Choi
authors.forename: Kiwon
authors.initials: K
authors.lastname: Lee
mesh_terms: D000368:Aged; D001929:Brain Edema / Q000453:epidemiology / Q000517:prevention & control; D002545:Brain Ischemia / Q000601:surgery*; D002548:Cerebral Revascularization / Q000009:adverse effects / Q000379:methods*; D004562:Electrocardiography; D005260:Female; D006801:Humans; D007036:Hypothermia, Induced / Q000009:adverse effects; D007091:Image Processing, Computer-Assisted; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D009460:Neurologic Examination; D019635:Neurosurgical Procedures / Q000009:adverse effects / Q000379:methods*; D011182:Postoperative Care; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control*; D012044:Regression Analysis; D012307:Risk Factors; D020521:Stroke / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
keywords: hypothermia; ischemia; ischemic; neuroprotection; reperfusion injury; stroke