Hypothermia and Ischemic Stroke.

Abstract

OPINION STATEMENT: The use of tissue plasminogen activator (tPA) is the major treatment method for acute ischemic stroke, but it reaches only a very limited number of stroke patients. Although neuroprotectants may be useful in stroke patients in principle, promising animal data have not yet been successfully transferred to stroke patients. However, many arguments favor the successful translation of therapeutic hypothermia (TH) to stroke patients: it is a multimodal method, there is a strong correlation between fever and outcome in stroke patients, and TH has been shown to be beneficial in other kinds of acute brain injury (resuscitation, perinatal asphyxia). In addition, it is useful in controlling intracranial pressure caused by brain edema. So far, available data from clinical studies are not sufficient to recommend TH for the routine treatment of acute ischemic stroke. The quality of trials and the number of stroke patients treated by TH are far too low to prove efficacy or futility, but multicenter randomized controlled clinical trials are on their way. Studies in awake stroke patients will use TH very early in the clinical setting, which implies certain problems. The use of TH in awake individuals requires methods to suppress cold-induced vegetative responses such as shivering and sympathic activation, clinically relevant side effects that need to be monitored and treated carefully. In mass-occupying ischemic stroke, randomized trials will evaluate the neuroprotective effects of controlling edema and intracranial pressure. Because the optimal depth, duration, and methods of cooling are not clear, only large randomized controlled trials will set the baseline from which TH as a neuroprotective therapy can be optimized and brought successfully to stroke patients.

Full text

Page 1

Page 2

THERAPEUTIC
HYPOTHERMIA

Page 3

Page 4

THERAPEUTIC
HYPOTHERMIA
Stephan A. Mayer
Columbia University Medical Center
New York, New York, U.S.A.
Daniel I. Sessler
University of Louisville
Louisville, Kentucky, U.S.A.
edited by
MARCEL DEKKER NEW YORK

Page 5

Although great care has been taken to provide accurate and current information, neither the
author(s)northepublisher,noranyoneelseassociatedwiththispublication,shallbeliablefor
anyloss,damage,or liabilitydirectlyorindirectlycausedorallegedtobecausedbythisbook.
The material contained herein is not intended to provide specific advice or recommendations
for any specific situation.
Trademark notice: Product or corporate names may be trademarks or registered trademarks
and are used only for identification and explanation without intent to infringe.
Library of Congress Cataloging-in-Publication Data
A catalog record for this book is available from the Library of Congress.
ISBN: 0-8247-5478-7
This book is printed on acid-free paper.
Headquarters
Marcel Dekker, 270 Madison Avenue, New York, NY 10016, U.S.A.
tel: 212-696-9000; fax: 212-685-4540
Distribution and Customer Service
Marcel Dekker, Cimarron Road, Monticello, New York 12701, U.S.A.
tel: 800-228-1160; fax: 845-796-1772
World Wide Web
http://www.dekker.com
Copyright n n n n n n n 2005 by Marcel Dekker. All Rights Reserved.
Neither this book nor any part may be reproduced or transmitted in any form or by any
means, electronic or mechanical, including photocopying, microfilming, and recording, or by
any information storage and retrieval system, without permission in writing from the
publisher.
Current printing (last digit):
10 9 8 7 6 5 4 3 2 1
PRINTED IN THE UNITED STATES OF AMERICA