Introduction: Endovascular therapy (EVT) is the only proven reperfusion strategy for basilar artery occlusion, while outcomes remain suboptimal as compared with anterior circulation stroke. Hypothermia is a well-recognized neuroprotectant but systemic cooling carries significant risks. To date, no targeted hypothermia approach has been systematically tested in posterior circulation acute ischemic stroke (AIS). This study aimed to evaluate the safety, feasibility, and preliminary efficacy of Vertebrobasilar Artery Cooling Infusion (VACI), a novel intra-arterial, selective hypothermia strategy delivered during EV in patients with basilar artery occlusion. Methods: In this prospective randomized controlled study (ID: ChiCTR2200065806), 40 patients with basilar artery occlusion undergoing EVT were randomized 1:1 to receive VACI (300 ml of 4 °C saline at 30 ml/min via vertebral artery immediately post-thrombectomy) or control (same volume of 37 °C saline). All patients enrolled received standard care according to current guidelines for stroke management. The primary outcome is symptomatic intracranial hemorrhage (sICH), whereas the secondary outcomes include functional outcome, infarction volume, mortality, ICH, fatal ICH, cerebral vasospasm, coagulation abnormality, pneumonia and urinary infection. Results: All patients completed follow-up. There was no significant difference in the incidence of symptomatic intracranial hemorrhage (sICH) between VACI and control groups. Rates of neurological deterioration and other complications were also compatible between groups. Notably, several favorable trends were observed in the VACI group. These included improved early neurological recovery (median NIHSS at 24 hours: 6 vs. 12.5, p =0.051) and reduced final infarct volume (9.0 ml vs. 17.5 ml). Furthermore, the hypothermia group exhibited a clinically notable reduction in mortality at both 90 days (10.0% vs. 20.0%;) and, more prominently at 7 days (5.0% vs. 20.0%). While these differences did not reach statistical significance, they consistently favored the hypothermia group. Conclusion: This study represents the first randomized trial of selective intra-arterial hypothermia in posterior circulation stroke, demonstrating both safety and preliminary signals of benefit. By integrating targeted cooling into EVT, VACI introduces a novel paradigm that may enhance outcomes in this high-risk population. Larger multicenter trials are warranted to confirm its therapeutic benefit.
Cheng et al. (Thu,) studied this question.
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