Alireza Noorian, MD

Hong JM, Lee JS, Song HJ, Jung HS, Choi HA, and Lee K. Therapeutic Hypothermia After Recanalization in Patients With AcuteIschemic Stroke. Stroke. 2013

Therapeutic Hypothermia (TH) is one of the neuroprotective strategies that can potentially be beneficial in acute ischemic stroke especially along with fast recanalization, by impacting multiple molecular pathways including excitotoxicity, oxidative injury, inflammatory response and ischemia-reperfusion injury.



In their recent study, Hong et al, did a prospective analysis on acute ischemic strokes due to large vessel occlusion strokes in the anterior circulation with NIHSS≥10 with successful recanalization (≥TICI 2b). They investigated the clinical and radiological outcomes in two groups of these patients, with and without TH (mild [34.5 C], over 48 hr period with rewarming in the following 48 hrs) in two centers along with mechanical ventilation and standard medical care in both centers.
The hypothermia group had less cerebral edema, hemorrhagic transformation and better functional outcome in a statistically significant manner compared to the normothermic group. There was no difference in the rate of mortality, hemicraniectomy rate and medical complications. Following adjustments for confounders, TH and distal occlusions were the independent predictors for good outcome. 

Despite being a small pilot study, inherent differences in the two treatment centers, the study points towards a potential benefit for concurrent hypothermia along with recanalization strategies to improve outcome, which should be considered in future randomized trials.