title: Impact of immediate post-reperfusion cooling on outcome in patients with acute stroke and substantial ischemic changes.
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.
authors.affiliation: Department of Neurology, Kyungpook National University School of Medicine and Hospital, Daegu, South Korea.|Cerebrovascular Center, Kyungpook National University School of Medicine and Hospital, Daegu, South.
authors.forename: Yang-Ha
authors.identifier: http://orcid.org/0000-0002-6665-7481
authors.initials: YH
authors.lastname: Hwang
authors.affiliation: Department of Neurology, Kyungpook National University School of Medicine and Hospital, Daegu, South Korea.
authors.forename: Ji-Su
authors.initials: JS
authors.lastname: Jeon
authors.affiliation: Department of Neurology, Kyungpook National University School of Medicine and Hospital, Daegu, South Korea.|Cerebrovascular Center, Kyungpook National University School of Medicine and Hospital, Daegu, South.|Department of Radiology,  Kyungpook National University School of Medicine and Hospital, Daegu, South Korea.
authors.forename: Yong-Won
authors.initials: YW
authors.lastname: Kim
authors.affiliation: Cerebrovascular Center, Kyungpook National University School of Medicine and Hospital, Daegu, South.|Department of Radiology,  Kyungpook National University School of Medicine and Hospital, Daegu, South Korea.|Department of Neurosurgery, Kyungpook National University School of Medicine and Hospital, Daegu, South Korea.
authors.forename: Dong-Hun
authors.initials: DH
authors.lastname: Kang
authors.affiliation: Cerebrovascular Center, Kyungpook National University School of Medicine and Hospital, Daegu, South.|Department of Radiology,  Kyungpook National University School of Medicine and Hospital, Daegu, South Korea.
authors.forename: Yong-Sun
authors.initials: YS
authors.lastname: Kim
authors.affiliation: UCLA Stroke Center, University of California, Los Angeles, California, USA.
authors.forename: David S
authors.initials: DS
authors.lastname: Liebeskind
mesh_terms: D000368:Aged; D002545:Brain Ischemia / Q000000981:diagnostic imaging* / Q000628:therapy*; D003080:Cold Temperature; D017679:Cryotherapy / Q000379:methods*; D057510:Endovascular Procedures / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D015424:Reperfusion / Q000379:methods*; D012189:Retrospective Studies; D020521:Stroke / Q000000981:diagnostic imaging* / Q000628:therapy*; D016896:Treatment Outcome
keywords: Intervention; MRI; Stroke