COmbination of Targeted temperature management and Thrombectomy after acute Ischemic Stroke(COTTIS):a pilot study  

作　　者：Jürgen Bardutzky Rainer Kollmar Forat Al-Rawi Johann Lambeck Mohammad Fazel Christian Taschner Wolf-Dirk Niesen 

机构地区：[1]Department of Neurology and Neurophysiology,Medical Center-University of Freiburg,Faculty of Medicine,University of Freiburg,Freiburg,Germany [2]Neurology and Neurointensive Care,Darmstadt Hospital,Darmstadt,Germany [3]BrainCool AB,Lund,Sweden [4]Department of Neuroradiology,Medical Center-University of Freiburg,Faculty of Medicine,University of Freiburg,Freiburg,Germany

出　　处：《Stroke & Vascular Neurology》2024年第3期258-267,共10页卒中与血管神经病学（英文）

基　　金：JB got his salary paid in part through the EU project Horizon-2020,project Acronym CUCUMBER;project number 958809.

摘　　要：Background To evaluate the feasibility and safety of a fast initiation of cooling to a target temperature of 35℃by means of transnasal cooling in patients with anterior circulation large vessel occlusion(LVO)undergoing endovascular thrombectomy(EVT).Methods Patients with an LVO onset of<24hour who had an indication for EVT were included in the study.Transnasal cooling(RhinoChill)was initiated immediately after the patient was intubated for EVT and continued until an oesophageal target temperature of 35℃was reached.Hypothermia was maintained with surface cooling for 6-hour postrecanalisation,followed by active rewarming(+0.2℃/hour).The primary outcome was defined as the time required to reach 35℃,while secondary outcomes comprised clinical,radiological and safety parameters.Results Twenty-two patients(median age,77 years)were included in the study(14 received additional thrombolysis,4 additional stenting of the proximal internal carotid artery).The median time intervals were 309min for last-seen-normal-to-groin,58min for door-to-cooling-initiation,65min for door-to-groin and 123min for door-to-recanalisation.The target temperature of 35℃was reached within 30min(range 13–78min),corresponding to a cooling rate of 2.6℃/hour.On recanalisation,86%of the patients had a body temperature of≤35℃.The median National Institutes of Health Stroke Scale at admission was 15 and improved to 2 by day 7,and 68%of patients had a good outcome(modified Rankin Scale 0–2)at 3 months.Postprocedure complications included asymptomatic bradycardia(32%),pneumonia(18%)and asymptomatic haemorrhagic transformation(18%).Conclusion The combined application of hypothermia and thrombectomy was found to be feasible in sedated and ventilated patents.Adverse events were comparable to those previously described for EVT in the absence of hypothermia.The effect of this procedure will next be evaluated in the randomised COmbination of Targeted temperature management and Thrombectomy after acute Ischemic Stroke-2 trial.

关 键 词：maintained continued initiated 

分 类 号：R743.3[医药卫生—神经病学与精神病学]