Safety, feasibility, and potential efficacy of intraarterial selective cooling infusion for stroke patients treated with mechanical thrombectomy

Abstract

This is a prospective non-randomized cohort study of 113 consecutive patients to investigate the safety and efficacy of a short-duration intraarterial selective cooling infusion (IA-SCI) targeted into an ischemic territory combined with mechanical thrombectomy (MT) in patients with large vessel occlusion-induced acute ischemic stroke (AIS); 45/113 patients underwent IA-SCI with 350 ml 0.9% saline at 4℃ for 15 min at the discretion of the interventionalist. Key parameters such as vital signs and key laboratory values, symptomatic and any intracranial hemorrhage, coagulation abnormalities, pneumonia, urinary tract infections and mortality were not significantly different between the two groups. Final infarct volume (FIV) was assessed on noncontrast CT performed at three to seven days. After an adjusted regression analysis, the between-group difference in FIV (19.1 ml; 95% confidence interval (CI) 3.2 to 25.2; P = 0.038) significantly favored the IA-SCI group. At 90 days, no differences were found in the proportion of patients who achieved functional independence (mRS 0-2) (51.1% versus. 41.2%, adjusted odd ratio (aOR) 1.9, 95% CI 0.8-2.6, P = 0.192). Combining short-duration IA-SCI with MT was safe. There was a smaller FIV and trend towards clinical benefit that will need to be further evaluated in randomized control trials.

Keywords: Hypothermia; endovascular procedures; intra-arterial infusions; neuroprotection; reperfusion injury.

Figure 1.

Sketch map of the intraarterial selective cooling infusion procedure. Before recanalization, a micro catheter reached beyond the clot responsible for the ischemic symptoms, then a 50 ml cold 0.9% saline (4℃) aliquot was infused into the ischemic territory at 10 ml/min through the micro catheter (Panel A). After that, mechanical thrombectomy with a stent retriever was performed to recanalize the occluded vessel as soon as possible. Immediately after mechanical thrombectomy, cold 0.9% saline (4℃) was re-infused into the ischemic brain tissue through the catheter at a rate of 30 ml/min for 10 min (Panel B).

Figure 2.

Summary of patients’ disposition. Of 239 patients screened, 113 patients were analyzed and 45 patients received a selective brain cooling infusion. *28 patients had multiple reasons. ^†1 patient had multiple reasons.