Inadvertent hypothermia after endovascular therapy is not associated with improved outcome in stroke due to anterior circulation large vessel occlusion.

Published on Jun 4, 2021in European Journal of Neurology4.516
· DOI :10.1111/ENE.14906
Christian Hartmann1
Estimated H-index: 1
(TUD: Dresden University of Technology),
Simon Winzer5
Estimated H-index: 5
(TUD: Dresden University of Technology)
+ 10 AuthorsVolker Puetz4
Estimated H-index: 4
(TUD: Dresden University of Technology)
Sources
Abstract
BACKGROUND AND PURPOSE Hypothermia may be neuroprotective in acute ischemic stroke. Patients with anterior circulation large vessel occlusion (acLVO) are frequently hypothermic after endovascular therapy (EVT). We sought to determine whether this inadvertent hypothermia is associated with improved outcome. METHODS We extracted data of consecutive patients (01/2016-05/2019) who received EVT for acLVO from our prospective EVT register of all patients screened for EVT at our tertiary stroke center. We assessed functional outcome at 3 months and performed multivariable analysis to calculate adjusted risk ratios (aRR) for favorable outcome (mRS scores 0 to 2) and mortality across patients who were hypothermic (<36°C) and patients who were normothermic (≥36°C to <37.6°C) after EVT. Moreover, we compared the frequency of complications between these groups. RESULTS Among 837 patients screened, 416 patients received EVT for acLVO and fulfilled inclusion criteria (200 [48.1%] male, mean age 76±16 years, median [IQR] NIHSS score 16 [12-20]). Of these, 209 patients (50.2%) were hypothermic (median [IQR] temperature 35.2°C [34.7-35.7]) and 207 patients were normothermic (median [IQR] temperature 36.4°C [36.1-36.7]) after EVT. In multivariable analysis, hypothermia was not associated with favorable outcome (aRR 0.99; 95%CI 0.75-1.31) and mortality (aRR 1.18; 95%CI 0.84-1.66). More hypothermic patients suffered from pneumonia (36.4% vs. 25.6%; p=0.02) and bradyarrhythmia (52.6% vs. 16.4%; p<0.001) whereas thromboembolic events were distributed evenly (5.7% vs. 6.8%; n.s.). CONCLUSION Inadvertent hypothermia after EVT for acLVO is not associated with improved functional outcome or reduced mortality but an increased rate of pneumonia and bradyarrhythmia in patients with acute ischemic stroke.
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Importance Moderate hypothermia in addition to early decompressive hemicraniectomy has been suggested to further reduce mortality and improve functional outcome in patients with malignant middle cerebral artery (MCA) stroke. Objective To investigate whether moderate hypothermia vs standard treatment after early hemicraniectomy reduces mortality at day 14 in patients with malignant MCA stroke. Design, Setting, and Participants This randomized clinical trial recruited patients from August 2011 thr...
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Background: The optimal sedative regimen with general anesthesia (GA) or conscious sedation for patients undergoing endovascular therapy (EVT) remains controversial. Apart from sedative regimen, the duration of anesthetic exposure may affect clinical outcomes. We aimed to determine whether there is an association between anesthetic exposure time and clinical outcomes in mechanically ventilated stroke patients undergoing EVT for large vessel occlusion. Methods: This was an observational study of ...
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#1Kosmas Macha (FAU: University of Erlangen-Nuremberg)H-Index: 7
#2Stefan Schwab (FAU: University of Erlangen-Nuremberg)H-Index: 87
Hypothermia and possible neuroprotective effects have been investigated in different conditions of acute ischemic stroke, including awake patients and patients with hemicraniectomy due to malignant middle cerebral artery infarction. Most of these were inconclusive and had the imminent problem of treatment delay. (1) Now at last, patients undergoing endovascular therapy (EVT) came into focus.
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