Neurocritical Care

, Volume 8, Issue 1, pp 42–47

Effect of Endovascular Hypothermia on Acute Ischemic Edema: Morphometric Analysis of the ICTuS Trial

Authors

    • Department of Emergency MedicineUCSD Medical Center
  • Haeryong Oh
    • UCSD School of Medicine
  • Sung-Wook Yu
    • Veterans Administration Medical Center
  • Brett C. Meyer
    • Department of Neurosciences, Department of NeurologyUCSD Medical Center
  • Karen Rapp
    • Department of Neurosciences, Department of NeurologyUCSD Medical Center
  • Patrick D. Lyden
    • Department of NeurosciencesUCSD Department of Neurology, Veterans Administration Medical Center
Original Paper

DOI: 10.1007/s12028-007-9009-z

Cite this article as:
Guluma, K.Z., Oh, H., Yu, S. et al. Neurocrit Care (2008) 8: 42. doi:10.1007/s12028-007-9009-z

Abstract

Introduction

Pilot studies of hypothermia for stroke suggest a potential benefit in humans. We sought to test whether hypothermia decreases post-ischemic edema using CT scans from a pilot trial of endovascular hypothermia for stroke.

Methods

Eighteen patients with acute ischemic stroke underwent therapeutic hypothermia (target = 33°C) for 12 or 24 h followed by a 12-h controlled re-warm using an endovascular system. CT scans obtained at baseline, 36–48 h (right after cooling and re-warming) and 30 days were digitized, intracranial compartment volumes measured using a validated stereological technique, and the calculated change in CSF volume between the three time-points were used as an estimate of edema formation in each patient. Patients were grouped retrospectively for analysis based on whether they cooled effectively (i.e., to a temperature nadir of less than 34.5°C within 8 h) or not.

Results

Eleven patients were cooled partially or not at all, and seven were effectively cooled. Baseline demographics and compartment volumes and densities were similar in both groups. At 36–48 h, the total CSF volume had significantly decreased in the not-cooled group compared to the cooled group (P < 0.05), with no significant difference in mean volume of ischemia between them (73 ± 73 ml vs. 54 ± 59 ml, respectively), suggesting an ameliorative effect of hypothermia on acute edema formation. At 30 days, the difference in CSF volumes had resolved, and infarct volumes (73 ± 71 ml vs. 84 ± 102 ml, respectively) and functional outcomes were comparable.

Conclusions

Endovascular hypothermia decreases acute post-ischemic cerebral edema. A larger trial is warranted to determine if it affects final infarct volume and outcome in stroke.

Keywords

Acute strokeInduced hypothermiaBrain edemaBody temperature X-ray computed tomography

Copyright information

© Humana Press Inc. 2007