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

Abstract

OBJECTIVE 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). METHODS 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. RESULTS 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. CONCLUSIONS 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.