Hartmann Christian, Winzer Simon, Pallesen Lars-Peder, Prakapenia Alexandra, Siepmann Timo, Moustafa Haidar, Theilen Hermann, Barlinn Jessica, Gerber Johannes C, Linn Jennifer, Reichmann Heinz, Barlinn Kristian, Puetz Volker
Department of Neurology, Dresden Neurovascular Center, Technische Universität Dresden, Dresden, Germany.
Department of Anesthesiology, Technische Universität Dresden, Dresden, Germany.
Eur J Neurol. 2021 Aug;28(8):2479-2487. doi: 10.1111/ene.14906. Epub 2021 Jun 4.
Hypothermia may be neuroprotective in acute ischemic stroke. Patients with anterior circulation large vessel occlusion (acLVO) are frequently hypothermic after endovascular therapy (EVT). We sought to determine whether this inadvertent hypothermia is associated with improved outcome.
We extracted data of consecutive patients (January 2016 to May 2019) who received EVT for acLVO from our prospective EVT register of all patients screened for EVT at our tertiary stroke center. We assessed functional outcome at 3 months and performed multivariate analysis to calculate adjusted risk ratios (aRRs) for favorable outcome (modified Rankin Scale scores = 0-2) and mortality across patients who were hypothermic (<36°C) and patients who were normothermic (≥36°C to <37.6°C) after EVT. Moreover, we compared the frequency of complications between these groups.
Among 837 patients screened, 416 patients received EVT for acLVO and fulfilled inclusion criteria (200 [48.1%] male, mean age = 76 ± 16 years, median National Institutes of Health Stroke Scale score = 16, interquartile range [IQR] = 12-20). Of these, 209 patients (50.2%) were hypothermic (median temperature = 35.2°C, IQR = 34.7-35.7) and 207 patients were normothermic (median temperature = 36.4°C, IQR = 36.1-36.7) after EVT. In multivariate analysis, hypothermia was not associated with favorable outcome (aRR = 0.99, 95% confidence interval [CI] = 0.75-1.31) and mortality (aRR = 1.18, 95% CI = 0.84-1.66). More hypothermic patients suffered from pneumonia (36.4% vs. 25.6%, p = 0.02) and bradyarrhythmia (52.6% vs. 16.4%, p < 0.001), whereas thromboembolic events were distributed evenly (5.7% vs. 6.8%, not significant).
Inadvertent hypothermia after EVT for acLVO is not associated with improved functional outcome or reduced mortality but is associated with an increased rate of pneumonia and bradyarrhythmia in patients with acute ischemic stroke.
低温可能对急性缺血性卒中具有神经保护作用。前循环大血管闭塞（acLVO）患者在血管内治疗（EVT）后常出现体温过低。我们试图确定这种意外的低温是否与改善的预后相关。
我们从我们三级卒中中心对所有接受EVT筛查的患者的前瞻性EVT登记册中提取了2016年1月至2019年5月因acLVO接受EVT的连续患者的数据。我们评估了3个月时的功能结局，并进行多变量分析以计算EVT后体温过低（<36°C）患者和体温正常（≥36°C至<37.6°C）患者获得良好结局（改良Rankin量表评分=0-2）和死亡率的调整风险比（aRRs）。此外，我们比较了这些组之间并发症的发生率。
在837例接受筛查的患者中，416例因acLVO接受了EVT并符合纳入标准（200例[48.1%]为男性，平均年龄=76±16岁，美国国立卫生研究院卒中量表评分中位数=16，四分位间距[IQR]=12-20）。其中，209例（50.2%）患者在EVT后体温过低（中位温度=35.2°C，IQR=34.7-35.7），207例患者体温正常（中位温度=36.4°C，IQR=36.1-36.7）。在多变量分析中，体温过低与良好结局（aRR=0.99，95%置信区间[CI]=0.75-1.31）和死亡率（aRR=1.18，95%CI=0.84-1.66）无关。更多体温过低的患者患有肺炎（36.4%对25.6%，p=0.02）和缓慢性心律失常（52.6%对16.4%，p<0.001），而血栓栓塞事件分布均匀（5.7%对6.8%，无统计学意义）。
acLVO患者EVT后意外的体温过低与功能结局改善或死亡率降低无关，但与急性缺血性卒中患者肺炎和缓慢性心律失常的发生率增加有关。
