Is hypothermia useful in malignant ischemic stroke? Current status and future perspectives

Abstract

Background and aims: In acute stroke patients, mild and moderate hypothermia with a body temperature (T core) target of 32 degrees C to 34 degrees C is being tested and has shown some promising results. The feasibility of MH to control of ICP increases in patients with malignant ischemic stroke has been proven, but controversy as to its effectiveness and safety still continues. The most recent results of clinical trials and possible future applications of MH in acute stroke patients are analyzed in this review. Design, methods and material: A search in MEDLFNE/PubMed was performed. The references of selected articles were investigated and the Cochrane Library searched. Articles including severe, massive, malignant or hemispheric ischemic stroke, induced hypothermia, and animal studies with focal cerebral or brain ischemic models were considered.

Results: 196 patients with ischemic stroke treated with hypothermia have been reported in eleven small clinical studies, with a mild benefit of MH over the mortality rate and final outcome.

Conclusions: Moderate hypothermia ameliorates ischemic injury by multiple mechanisms. Treatment of acute ischemic stroke patients is feasible, and additional studies, including randomized clinical trials, are warranted.