J Neurocrit Care.  2019 Dec;12(2):67-73. 10.18700/jnc.190100.

Targeted temperature management for ischemic stroke

Affiliations
  • 1Department of Neurology, Ajou University School of Medicine, Suwon, Republic of Korea. dacda@hanmail.net

Abstract

Therapeutic hypothermia (TH) or targeted temperature management is an intentional cooling or temperature control technique using a thermostatic equipment (i.e., surface, endovascular, and focal devices) for specific therapeutic purposes. Given the modifiable determinants in the therapeutic process of acute ischemic stroke, hemorrhagic stroke, and subarachnoid hemorrhage, several studies strongly reported that fever is closely associated with more harmful neurological outcomes. Fever or hyperthermia can deteriorate the cellular ischemic cascade, causing more cerebral damage owing to increased metabolic demands, enhanced release of excitatory neurotransmitters, and increased toxic free radical production. Despite the disappointing results of various clinical trials on TH in the stroke field, many studies have repeatedly clarified its fundamental mechanisms, which proved its strong neuroprotection in experimental stroke models. In particular, the potential effectiveness of TH can be revisited in the era of endovascular thrombectomy for patients undergoing emergent large-vessel occlusion because neuroprotection is maximized in ischemia-reperfusion injury models. This review aims to incorporate current literature into risks and benefits in patients with ischemic stroke.

Keyword

Hypothermia; Hypothermia, induced; Reperfusion injury; Reperfusion

MeSH Terms

Fever
Humans
Hypothermia
Hypothermia, Induced
Neuroprotection
Neurotransmitter Agents
Reperfusion
Reperfusion Injury
Risk Assessment
Stroke*
Subarachnoid Hemorrhage
Thrombectomy
Neurotransmitter Agents
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