What is the role of targeted temperature management (TTM) in patients with acute stroke?

Updated: Jul 26, 2019
  • Author: Alex Koyfman, MD; Chief Editor: Karlheinz Peter, MD, PhD  more...
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Answer

Considerable experimental evidence and clinical experience demonstrate that hypothermia reduces the volume of infarct and may preserve and restore the at-risk neurons in the penumbra in focal ischemic brain injury. [65, 66] Strong evidence suggests that hyperthermia (fever) is correlated with poor clinical outcomes. [67] Case-control studies and ongoing clinical trials in humans continue to evaluate the role of hypothermia in acute stroke. However, to date, large, prospective randomized human clinical trials to support the widespread adoption of hypothermia in acute stroke have not been completed. [66, 68]

Preliminary results from the prospective single-arm, open-label ReCCLAIM (Re perfusion and ooling in erebracute Ischeia) study indicate that hypothermia (target temperature of 33ºC) can be safely used following intra-arterial reperfusion therapy (IAT) in patients with large pretreatment core infarcts. [69] Phase 2 of this trial will randomize patients with acute ischemic stroke to hypothermia or normothermia.

A 2016 pilot study of endovascular hypothermia with cold isotonic saline infusion (4ºC) in 26 patients with acute ischemic stroke demonstrated 100% technical success and no reports of obvious complications associated with the intra-arterial hypothermia. [70]


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