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The Clinical Usefulness of Targeted Temperature Management in Acute Ischemic Stroke with Malignant Trait After Endovascular Thrombectomy

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Author(s)
Mun Hee Choi Young Eun Gil Seong-Joon LeeJin Soo Lee Jeong-Ho Hong Sung-Il Sohn Yong-Won Kim Yang-Ha HwangJi Man Hong 
Keimyung Author(s)
Hong, Jeong HoSohn, Sung Il
Department
Dept. of Neurology (신경과학)
Journal Title
Neurocrit Care
Issued Date
2021
Volume
34
Issue
3
Keyword
Targeted temperature managementMalignant MCA infarctNeuroprotectionEndovascular treatment
Abstract
Background/Objective:
Targeted temperature management (TTM) may be more beneficial after endovascular treatment (EVT) in patients with a large ischemic core. Therefore, we assessed the usefulness of TTM for such patients from a multicenter endovascular registry.

Methods:
Anterior circulation stroke patients who underwent endovascular recanalization were included; acute ischemic stroke with malignant traits was designated as (1) baseline Alberta Stroke Program Early CT Score (ASPECTS) below 6 and (2) diffusion-weighted imaging (DWI) lesion volume measurement (> 82 ml) or National Institutes of Health Stroke Scale score > 20 and item Ia > 0. TTM (34.5 °C) was maintained for at least 48 h.

Results:
We evaluated baseline demographics, risk factors, EVT parameters, and clinical outcomes between the TTM and non-TTM groups. Among the 548 patients, the TTM group (n = 91) significantly had a lower baseline ASPECTS (p < 0.001) and a higher DWI volume (p < 0.001) than the non-TTM group (n = 457). TTM group had a lower prevalence of favorable outcome (0–2 of modified Rankin Scale at 3 months; p = 0.008) than the non-TTM group. In a subgroup analysis of malignant trait patients (n = 80), TTM patients (n = 28) had more favorable outcome (32.1% vs. 7.7% p = 0.009) and less hemorrhagic transformation (none vs. any hemorrhage, p = 0.007) than non-TTM patients (n = 52). After adjusting for potential outcome predictors, TTM (odds ratio [OR] 4.63; confidence interval [CI] 1.20–17.89; p = 0.026) and hypertension (OR 0.18; CI 0.04–0.74; p = 0.018) were found to be independent determinants.

Conclusions:
Our data suggest that TTM attenuates impending hemorrhagic transformation and leads to favorable clinical outcomes in EVT patients with malignant trait.
Keimyung Author(s)(Kor)
홍정호
손성일
Publisher
School of Medicine (의과대학)
Citation
Mun Hee Choi et al. (2021). The Clinical Usefulness of Targeted Temperature Management in Acute Ischemic Stroke with Malignant Trait After Endovascular Thrombectomy. Neurocrit Care, 34(3), 990–999. doi: 10.1007/s12028-020-01069-0
Type
Article
ISSN
1566-0961
Source
https://link.springer.com/article/10.1007%2Fs12028-020-01069-0
DOI
10.1007/s12028-020-01069-0
URI
https://kumel.medlib.dsmc.or.kr/handle/2015.oak/43552
Appears in Collections:
1. School of Medicine (의과대학) > Dept. of Neurology (신경과학)
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