Interrupted intraarterial selective cooling infusion combined with mechanical thrombectomy in patients with acute ischemic stroke: a prospective, nonrandomized observational cohort study.

Abstract

The authors aimed to explore the feasibility and efficiency of an interrupted intraarterial selective cooling infusion (IA-SCI) combined with mechanical thrombectomy (MT) in patients with acute ischemic stroke (AIS). This prospective, nonrandomized observational cohort study included consecutive patients with AIS who had undergone MT at a stroke center from December 2018 to April 2022. Subjects were classified into an interrupted IA-SCI group and MT-alone group. The primary outcome was a favorable functional outcome (modified Rankin Scale score 0-2) at 90 days, and safety outcomes comprised the incidence of vasospasm, abnormal hematocrit (HCT), abnormal blood coagulation, pneumonia, infection, symptomatic intracranial hemorrhage, and death at 90 days. A total of 142 patients were ultimately enrolled in this study (62 in the interrupted IA-SCI plus MT group and 80 in the MT-alone group). Interrupted IA-SCI combined with MT reduced the final infarct core area volumes (28.4 ml, 95% CI 7.8-34.5, p = 0.025) and improved the clinical outcome at 3 months after stroke (mRS score 0-2, 54.8% vs 37.5%, aOR 2.4, 95% CI 1.4-3.5, p = 0.022). The incidence of vasospasm, abnormal HCT, pneumonia, abnormal blood coagulation, infection, symptomatic intracranial hemorrhage, and death at 90 days was not increased in the interrupted IA-SCI group. Interrupted IA-SCI for patients with intracranial large vessel occlusion AIS symptoms treated with MT seems to be safe and associated with favorable functional outcomes.