Impact of immediate post-reperfusion cooling on outcome in patients with acute stroke and substantial ischemic changes

被引：20

作者：

Hwang, Yang-Ha ^{[1
,2
]}

Jeon, Ji-Su ^{[1
]}

Kim, Yong-Won ^{[1
,2
,3
]}

Kang, Dong-Hun ^{[2
,3
,4
]}

Kim, Yong-Sun ^{[2
,3
]}

Liebeskind, David S. ^{[5
]}

机构：

[1] Kyungpook Natl Univ, Sch Med & Hosp, Dept Neurol, Daegu, South Korea

[2] Kyungpook Natl Univ, Sch Med & Hosp, Cerebrovasc Ctr, Daegu, South Korea

[3] Kyungpook Natl Univ, Sch Med & Hosp, Dept Radiol, Daegu, South Korea

[4] Kyungpook Natl Univ, Sch Med & Hosp, Dept Neurosurg, Daegu, South Korea

[5] Univ Calif Los Angeles, UCLA Stroke Ctr, Los Angeles, CA USA

来源：

JOURNAL OF NEUROINTERVENTIONAL SURGERY | 2017年 / 9卷 / 01期

关键词：

ENDOVASCULAR REPERFUSION; COMPUTED-TOMOGRAPHY; THROMBECTOMY; HYPOTHERMIA; THERAPY; TRIAL; RETRIEVER; SCORE;

D O I：

10.1136/neurintsurg-2015-012233

中图分类号：

R445 [影像诊断学];

学科分类号：

100207 ;

摘要：

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 hy pothermia 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.

引用

页码：21 / 25

页数：5

共 23 条

[1] Metabolic Impact of Shivering During Therapeutic Temperature Modulation The Bedside Shivering Assessment Scale [J].

Badjatia, Neeraj ;

Strongilis, Evangelia ;

Gordon, Errol ;

Prescutti, Mary ;

Fernandez, Luis ;

Fernandez, Andres ;

Buitrago, Manuel ;

Schmidt, J. Michael ;

Ostapkovich, Noeleen D. ;

Mayer, Stephan A. .

STROKE, 2008, 39 (12) :3242-3247

[2] A Randomized Trial of Intraarterial Treatment for Acute Ischemic Stroke [J].

Berkhemer, O. A. ;

Fransen, P. S. S. ;

Beumer, D. ;

van den Berg, L. A. ;

Lingsma, H. F. ;

Yoo, A. J. ;

Schonewille, W. J. ;

Vos, J. A. ;

Nederkoorn, P. J. ;

Wermer, M. J. H. ;

van Walderveen, M. A. A. ;

Staals, J. ;

Hofmeijer, J. ;

van Oostayen, J. A. ;

Nijeholt, G. J. Lycklama A. ;

Boiten, J. ;

Brouwer, P. A. ;

Emmer, B. J. ;

de Bruijn, S. F. ;

van Dijk, L. C. ;

Kappelle, L. J. ;

Lo, R. H. ;

Van Dijk, E. J. ;

de Vries, J. ;

de Kort, P. L. M. ;

van Rooij, W. J. J. ;

van den Berg, J. S. P. ;

van Hasselt, B. A. A. M. ;

Aerden, L. A. M. ;

Dallinga, R. J. ;

Visser, M. C. ;

Bot, J. C. J. ;

Vroomen, P. C. ;

Eshghi, O. ;

Schreuder, T. H. C. M. L. ;

Heijboer, R. J. J. ;

Keizer, K. ;

Tielbeek, A. V. ;

den Hertog, H. M. ;

Gerrits, D. G. ;

van den Berg-Vos, R. M. ;

Karas, G. B. ;

Steyerberg, E. W. ;

Flach, H. Z. ;

Marquering, H. A. ;

Sprengers, M. E. S. ;

Jenniskens, S. F. M. ;

Beenen, L. F. M. ;

van den Berg, R. ;

Koudstaal, P. J. .

NEW ENGLAND JOURNAL OF MEDICINE, 2015, 372 (01) :11-20

[3] Endovascular Therapy for Ischemic Stroke with Perfusion-Imaging Selection [J].

Campbell, B. C. V. ;

Mitchell, P. J. ;

Kleinig, T. J. ;

Dewey, H. M. ;

Churilov, L. ;

Yassi, N. ;

Yan, B. ;

Dowling, R. J. ;

Parsons, M. W. ;

Oxley, T. J. ;

Wu, T. Y. ;

Brooks, M. ;

Simpson, M. A. ;

Miteff, F. ;

Levi, C. R. ;

Krause, M. ;

Harrington, T. J. ;

Faulder, K. C. ;

Steinfort, B. S. ;

Priglinger, M. ;

Ang, T. ;

Scroop, R. ;

Barber, P. A. ;

McGuinness, B. ;

Wijeratne, T. ;

Phan, T. G. ;

Chong, W. ;

Chandra, R. V. ;

Bladin, C. F. ;

Badve, M. ;

Rice, H. ;

de Villiers, L. ;

Ma, H. ;

Desmond, P. M. ;

Donnan, G. A. ;

Davis, S. M. .

NEW ENGLAND JOURNAL OF MEDICINE, 2015, 372 (11) :1009-1018

[4] Randomized Assessment of Rapid Endovascular Treatment of Ischemic Stroke [J].

Goyal, M. ;

Demchuk, A. M. ;

Menon, B. K. ;

Eesa, M. ;

Rempel, J. L. ;

Thornton, J. ;

Roy, D. ;

Jovin, T. G. ;

Willinsky, R. A. ;

Sapkota, B. L. ;

Dowlatshahi, D. ;

Frei, D. F. ;

Kamal, N. R. ;

Montanera, W. J. ;

Poppe, A. Y. ;

Ryckborst, K. J. ;

Silver, F. L. ;

Shuaib, A. ;

Tampieri, D. ;

Williams, D. ;

Bang, O. Y. ;

Baxter, B. W. ;

Burns, P. A. ;

Choe, H. ;

Heo, J. -H. ;

Holmstedt, C. A. ;

Jankowitz, B. ;

Kelly, M. ;

Linares, G. ;

Mandzia, J. L. ;

Shankar, J. ;

Sohn, S. -I. ;

Swartz, R. H. ;

Barber, P. A. ;

Coutts, S. B. ;

Smith, E. E. ;

Morrish, W. F. ;

Weill, A. ;

Subramaniam, S. ;

Mitha, A. P. ;

Wong, J. H. ;

Lowerison, M. W. ;

Sajobi, T. T. ;

Hill, M. D. .

NEW ENGLAND JOURNAL OF MEDICINE, 2015, 372 (11) :1019-1030

[5] Effect of Baseline CT Scan Appearance and Time to Recanalization on Clinical Outcomes in Endovascular Thrombectomy of Acute Ischemic Strokes [J].

Goyal, Mayank ;

Menon, Bijoy K. ;

Coutts, Shelagh B. ;

Hill, Michael D. ;

Demchuk, Andrew M. .

STROKE, 2011, 42 (01) :93-97

[6] Trial design and reporting standards for intra-arterial cerebral thrombolysis for acute ischemic stroke [J].

Higashida, RT ;

Furlan, AJ .

STROKE, 2003, 34 (08) :E109-E137

[7] Therapeutic Hypothermia After Recanalization in Patients With Acute Ischemic Stroke [J].

Hong, Ji Man ;

Lee, Jin Soo ;

Song, Hee-Jung ;

Jeong, Hye Seon ;

Choi, Huimahn Alex ;

Lee, Kiwon .

STROKE, 2014, 45 (01) :134-140

[8]

Horn CM, 2014, J NEUROINTERV SURG, V6, P91, DOI [10.1136/neurintsurg-2013-010656, 10.1136/neurintsurg-2013-010743]

[9] Impact of Diffusion-Weighted Imaging Alberta Stroke Program Early Computed Tomography Score on the Success of Endovascular Reperfusion Therapy [J].

Inoue, Manabu ;

Olivot, Jean-Marc ;

Labreuche, Julien ;

Mlynash, Michael ;

Tai, Waimea ;

Albucher, Jean-Francois ;

Meseguer, Elena ;

Amarenco, Pierre ;

Mazighi, Mikael .

STROKE, 2014, 45 (07) :1992-1998

[10]

Jeon SB, 2014, J STROKE, V16, P146

← 1 2 3 →