No benefits of hypothermia in patients treated with hemicraniectomy for large ischemic stroke

H. Schneider, P. Krüger, A. Algra, Jeannette Hofmeijer, H.B. van der Worp, E. Jüttler, K Vahedi, G. Schackert, H. Reichmann, V. Puetz

Research output: Contribution to journalArticleAcademicpeer-review

10 Citations (Scopus)

Abstract

Background

Space-occupying middle cerebral artery brain infarcts are associated with the development of brain edema, which may lead to cerebral herniation and death despite early hemicraniectomy.

Aims

To evaluate the benefit of therapeutic hypothermia in patients with space-occupying cerebral infarction treated with hemicraniectomy within 48 h of stroke onset.

Methods

Patients aged 18–60 years with space-occupying cerebral infarction treated with hemicraniectomy within 48 h and hypothermia (33–34°C) were selected from a single university hospital between 2001 and 2010 (n = 53). Patients treated with hemicraniectomy alone served as comparison group (n = 58), originating from three randomized controlled trials evaluating the effects of early decompressive surgery (DECIMAL, DESTINY, HAMLET). Primary outcome was the score on the modified Rankin scale at 12 months dichotomized between modified Rankin scale 0–3 and modified Rankin scale 4–6. Secondary outcome measures were modified Rankin scale score 0–4 and survival. Risk ratios were adjusted with Poisson regression.

Results

Mean patient age was 48 years. Median time from stroke onset to hemicraniectomy was 23.5 h in both treatment groups. Treatment with hypothermia had no effect on the primary outcome (modified Rankin scale 0–3 versus 4–6 (13/53 (25%) versus 24/58 (41%)); adjusted risk ratio 0.66, 95% confidence interval 0.38–1.13). Fewer patients treated with hypothermia had a modified Rankin scale score of 0–4 (21/53 (40%) versus 42/58 (72%); adjusted risk ratio 0.53, 95% confidence interval 0.37–0.76) and fewer patients survived (26/53 (49%) versus 46/58 (79%); adjusted risk ratio 0.60, 95% confidence interval 0.44–0.82).

Conclusions

In patients with space-occupying cerebral infarction, treatment with hypothermia had no additional benefit on functional outcome compared with treatment with hemicraniectomy alone.
Original languageEnglish
Pages (from-to)732-740
JournalInternational journal of stroke
Volume12
Issue number7
DOIs
Publication statusPublished - 2017
Externally publishedYes

Keywords

  • METIS-322160
  • IR-104635

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