Hypothermia is Associated with Improved Neurological Outcomes After Mechanical Thrombectomy

World Neurosurg. 2024 Jan:181:e126-e132. doi: 10.1016/j.wneu.2023.09.010. Epub 2023 Sep 9.

Abstract

Background: Acute ischemic stroke (AIS) is the second leading cause of death globally. Mechanical thrombectomy (MT) has improved patient prognosis but expedient treatment is still necessary to minimize anoxic injury. Lower intraoperative body temperature decreases cerebral oxygen demand, but the role of hypothermia in treatment of AIS with MT is unclear.

Methods: We retrospectively reviewed patients undergoing MT for AIS from 2014 to 2020 at our institution. Patient demographics, comorbidities, intraoperative parameters, and outcomes were collected. Maximum body temperature was extracted from minute-by-minute anesthesia readings, and patients with maximal temperature below 36°C were considered hypothermic. Risk factors were assessed by χ2 and multivariate ordinal regression.

Results: Of 68 patients, 27 (40%) were hypothermic. There was no significant association of hypothermia with patient age, comorbidities, time since last known well, number of passes intraoperatively, favorable revascularization, tissue plasminogen activator use, and immediate postoperative complications. Hypothermic patients exhibited better neurologic outcome at 3-month follow-up (P = 0.02). On multivariate ordinal regression, lower maximum intraoperative body temperature was associated with improved 3-month outcomes (P < 0.001), when adjusting for other factors influencing neurological outcomes. Other significant protective factors included younger age (P = 0.03), better revascularization (P = 0.03), and conscious sedation (P = 0.02).

Conclusions: Lower intraoperative body temperature during MT was independently associated with improved neurological outcome in this single center retrospective series. These results may help guide clinicians in employing therapeutic hypothermia during MT to improve long-term neurologic outcomes from AIS, although larger studies are needed.

Keywords: Hypothermia; Outcomes; Stroke; Thrombectomy.

MeSH terms

  • Brain Ischemia* / complications
  • Humans
  • Hypothermia*
  • Ischemic Stroke* / etiology
  • Retrospective Studies
  • Stroke* / etiology
  • Thrombectomy / methods
  • Tissue Plasminogen Activator / therapeutic use
  • Treatment Outcome

Substances

  • Tissue Plasminogen Activator