A novel approach to reduce hemorrhagic transformation after interventional management of acute stroke: catheter-based selective hypothermia.

Interventional management of acute stroke can significantly increase recanalization rate of the occluded artery, however, this improvement is achieved at the expense of an increased incidence in symptomatic intracranial hemorrhage, which may markedly reduce the therapeutic benefit of this treatment. Hypothermia is one of the most promising neuroprotective approaches studied. It may also lower the risk of postischemic hemorrhage by reducing the activities of matrix metalloproteinases and blood-brain barrier disruption. But in most clinical studies, hypothermia is induced by surface cooling. It has two major drawbacks. (1) Several hours are required to reach the target body core temperature. (2) The incidence of adverse effects, such as impaired immune function, shivering, pneumonia, and cardiac arrhythmias/bradycardias, is high. Selective brain hypothermia without reducing body core temperature can theoretically address both problems of whole body cooling. So it is hypothesized that interventional management of acute stroke combined with catheter-based selective brain hypothermia may reduce the risk of postischemic hemorrhagic transformation, at the same time circumventing the bulk of negative side effects associated with systemic hypothermia.