Non-invasive convective head cooling during stroke thrombectomy: A prospective multi-center feasibility trial.

IF 4.5 3区 医学 Q1 CLINICAL NEUROLOGY
William K Diprose, Catherine Veilleux, Mohammed Almekhlafi, Alec Beresford, Kaustubha Ghate, Davina McAllister, Michael Tm Wang, Jessica Wiles, Douglas Campbell, P Alan Barber
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引用次数: 0

Abstract

Introduction: Non-invasive convective head cooling is a promising putative neuroprotective therapy for ischemic stroke patients as it may portably, non-invasively, and selectively cool the ischemic penumbra. We aimed to investigate the feasibility of utilizing non-invasive convective head cooling in ischemic stroke patients before and during endovascular thrombectomy (EVT).

Patients and methods: We conducted a multi-center, prospective, non-randomized, open-label trial at two comprehensive stroke centers in ischemic stroke patients where EVT was planned. Patients were assessed for eligibility in the emergency department (ED) and had a cooling cap fitted that circulated coolant between -5°C and 0°C until EVT completion. The primary feasibility endpoint was adherence, defined as tolerating cooling for ⩾50% of the time from cooling cap application until EVT completion.

Results: Between July and November 2024, 40 EVT patients (19 (47.5%) female, mean ± SD age 71.6 ± 12.6 years) underwent a median (IQR) duration of convective head cooling of 86 (58-106) min. Thirty-nine (97.5%) participants met the primary feasibility endpoint. The enrollment rate was five participants per site per month. Median (IQR) time from comprehensive stroke center arrival to cooling start was 10 (5-51) min. Thirty-two (80%) patients received general anesthesia. eTICI 2b-3 reperfusion was achieved in 38 (95.0%) participants. Median (IQR) 24-h infarct volume was 14.3 (5.5-29.1) mL. Median (IQR) 3-month modified Rankin Scale score was 2 (1-5). Three-month mortality occurred in 8/38 (21.1%) participants. Nine serious adverse events occurred in 8 (20.0%) participants, none of which were attributed to head cooling.

Conclusions: Convective head cooling is feasible in patients undergoing EVT and warrants further investigation in larger randomized controlled trials.

脑卒中血栓切除术中无创对流头部冷却:一项前瞻性多中心可行性试验。
无创头部对流冷却是一种很有前途的缺血性脑卒中患者神经保护治疗方法,因为它可以便携、无创、选择性地冷却缺血性半暗带。我们的目的是探讨缺血性脑卒中患者在血管内取栓(EVT)之前和期间使用无创头部对流冷却的可行性。患者和方法:我们在两个综合卒中中心对缺血性卒中患者进行了一项多中心、前瞻性、非随机、开放标签的试验,这些患者计划进行EVT。评估患者在急诊科(ED)的资格,并安装冷却帽,在-5°C和0°C之间循环冷却剂,直到EVT完成。主要可行性终点是依从性,定义为从冷却帽应用到EVT完成的小于或等于50%时间的耐受冷却。结果:2024年7月至11月,40例EVT患者(女性19例(47.5%),平均±SD年龄71.6±12.6岁)接受了对流头部冷却的中位(IQR)持续时间为86(58-106)分钟。39名(97.5%)参与者达到了主要可行性终点。注册率为每个网站每月5名参与者。从综合冲程中心到达冷却开始的中位(IQR)时间为10(5-51)分钟。32例(80%)患者接受全身麻醉。38例(95.0%)受试者实现eTICI 2b-3再灌注。24小时梗死体积中位数(IQR)为14.3 (5.5-29.1)mL。3个月修正Rankin量表中位(IQR)评分为2(1-5)。3个月死亡率为8/38(21.1%)。8名(20.0%)参与者发生了9起严重不良事件,其中没有一起归因于头部冷却。结论:对流头部冷却在EVT患者中是可行的,值得在更大规模的随机对照试验中进一步研究。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
7.50
自引率
6.60%
发文量
102
期刊介绍: Launched in 2016 the European Stroke Journal (ESJ) is the official journal of the European Stroke Organisation (ESO), a professional non-profit organization with over 1,400 individual members, and affiliations to numerous related national and international societies. ESJ covers clinical stroke research from all fields, including clinical trials, epidemiology, primary and secondary prevention, diagnosis, acute and post-acute management, guidelines, translation of experimental findings into clinical practice, rehabilitation, organisation of stroke care, and societal impact. It is open to authors from all relevant medical and health professions. Article types include review articles, original research, protocols, guidelines, editorials and letters to the Editor. Through ESJ, authors and researchers have gained a new platform for the rapid and professional publication of peer reviewed scientific material of the highest standards; publication in ESJ is highly competitive. The journal and its editorial team has developed excellent cooperation with sister organisations such as the World Stroke Organisation and the International Journal of Stroke, and the American Heart Organization/American Stroke Association and the journal Stroke. ESJ is fully peer-reviewed and is a member of the Committee on Publication Ethics (COPE). Issues are published 4 times a year (March, June, September and December) and articles are published OnlineFirst prior to issue publication.
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