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Review
. 2024 Sep 19:15910199241285157.
doi: 10.1177/15910199241285157. Online ahead of print.

Selective intra-arterial hypothermia combined with endovascular thrombectomy for large vessel occlusion: A systematic review and meta-analysis

Fahad Alturki  1   2 , Ahmed Alkhiri  3   4 , Bander Alsulami  3   4 , Fawaz F Alotaibi  5 , Aser F Alamri  1   2 , Bader AlRuhaymi  1   2 , Elyas M Bakhuraybah  3   4 , Fahad S Al-Ajlan  5   6 , Adel Alhazzani  5   6 , Mohammed A Almekhlafi  7
Affiliations
Review

Selective intra-arterial hypothermia combined with endovascular thrombectomy for large vessel occlusion: A systematic review and meta-analysis

Fahad Alturki et al. Interv Neuroradiol. .

Abstract

Background: Systemic therapeutic hypothermia may improve outcomes after acute ischemic stroke but increases complications. Selective intra-arterial hypothermia at the ischemic site during endovascular thrombectomy (EVT) theoretically offers benefits with fewer risks. However, there is little clinical evidence to support this approach.

Methods: We searched Medline/PubMed, Embase and Cochrane electronic databases for studies evaluating the safety and feasibility of selective intra-arterial hypothermia as an adjunct to EVT for large vessel occlusion (LVO). Effect sizes with 95% confidence intervals (CIs) were pooled using the fixed-effect model. Odds ratios (ORs) were computed for binary variables, while the mean differences (MDs) were pooled for continuous data.

Results: Of identified records, five clinical studies involving 463 LVO patients (62.9% male) were included. Of those, 224 (48.4%) patients received adjuvant selective intra-arterial hypothermia, while 239 (51.6%) received EVT alone. Selective intra-arterial hypothermia resulted in higher rates of good functional outcome (modified Rankin scale [mRS] 0-2 at 90-days) (OR 2.07, [95% CI, 1.36 to 3.16]), and lower final infarct volume (MD, -20.96 ml [95% CI, -26.17 to -15.75]) and lower rates of severe disability (mRS 3-5 at 90 days) (OR 0.44 [95% CI, 0.26 to 0.75]). Safety parameters including rates of symptomatic intracerebral hemorrhage, mortality, pneumonia, coagulation abnormalities, and arterial spasm were comparable between groups.

Conclusions: The initial evidence supports the safety and feasibility of selective intra-arterial hypothermia when combined with EVT for LVO. This approach shows promise for advancing research on neuroprotective strategies for ischemic stroke.

Keywords: Stroke; endovascular thrombectomy; hypothermia; large vessel occlusion; neuroprotection; selective hypothermia.

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Conflict of interest statement

Declaration of conflicting interestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Prisma flow diagram of study selection process.
Figure 2.
Figure 2.
Forest plot of rates of good functional outcome (mRS 0-2) and final infarct volume.
Figure 3.
Figure 3.
Forest plot of rates of mortality and severe disability (mRS 3-5) at 90 days.
See this image and copyright information in PMC

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