Skip to main content

SYSTEMATIC REVIEW article

Front. Neurol.
Sec. Stroke
Volume 15 - 2024 | doi: 10.3389/fneur.2024.1481115
This article is part of the Research Topic Reviews in Acute Stroke and Interventional Therapies 2023 View all 6 articles

The efficacy of hypothermia combined with thrombolysis or mechanical thrombectomy on acute ischemic stroke: a systematic review and meta-analysis

Provisionally accepted
Dan Wang Dan Wang 1Dan Yan Dan Yan 1Mingmin Yan Mingmin Yan 1Hao Tian Hao Tian 1Haiwei Jiang Haiwei Jiang 1Bifeng Zhu Bifeng Zhu 1Yu Chen Yu Chen 1Tao Peng Tao Peng 1Yue Wan Yue Wan 1,2*
  • 1 Hubei NO.3 People’s Hospital of Jianghan University, Wuhan, China
  • 2 Jianghan University, Wuhan, Hubei Province, China

The final, formatted version of the article will be published soon.

    Background: Therapeutic hypothermia improves outcomes in experimental stroke models, especially after ischemia-reperfusion injury. In recent years, the safety and efficacy of hypothermia combining thrombolysis or mechanical thrombectomy have attracted widespread attention. The primary objective of the study was to evaluate the effectiveness and safety of hypothermia by combining reperfusion therapy in acute ischemic stroke patients. Methods: A systematic search was performed in PubMed, EMBASE, Cochrane Library, and the Clinical Trial Registries on articles published until May 2024. The full-text articles were thoroughly reviewed, and relevant information regarding study characteristics and outcomes was extracted.Mantel-Haenszel (M-H) random-effects model was used to calculate pooled risk ratios (RR) with 95% confidence intervals (CI). In addition, subgroup analyses were performed focusing on the different hypothermia modalities and duration. Results: After screening 2265 articles, 10 studies were included in the present analysis with a total sample size of 785. Forest plots of clinical outcomes were as follows: modified Rankin Scale (mRS) ≤ 2 at 3 months (RR = 1.28, 95% CI 1.01-1.61, p = 0.04), mortality within 3 months (RR = 0.95, 95% CI 0.69-1.29, p = 0.73), total complications (RR = 1.02, 95% CI 0.89-1.16, p = 0.77) and pneumonia (RR = 1.35, 95% CI 0.76-2.40, p = 0.31). Subgroup analyses indicated a mild protective effect of selective cerebral hypothermia; however, the difference in mortality between the hypothermia and control groups was not statistically significant (RR = 0.88, 95% CI 0.57-1.35, p = 0.55).Patients undergoing hypothermia for 24-48 hours experienced a higher rate of overall complications (RR = 1.37, 95% CI 1.01-1.86, p = 0.04) and pneumonia (RR = 2.84, 95% CI 1.05-7.66, p = 0.04). Conclusions: The preliminary evidence supports the safety and feasibility of hypothermia combined with reperfusion therapy, which should be further investigated in randomized controlled studies.

    Keywords: Therapeutic hypothermia, selective cerebral hypothermia, Acute ischemic stroke, thrombolysis, Mechanical thrombectomy, mRS Registration: PROSPERO, CRD42024556625

    Received: 15 Aug 2024; Accepted: 18 Dec 2024.

    Copyright: © 2024 Wang, Yan, Yan, Tian, Jiang, Zhu, Chen, Peng and Wan. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Yue Wan, Jianghan University, Wuhan, 430056, Hubei Province, China

    Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.