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(Circulation. 2002;106:1736.)
© 2002 American Heart Association, Inc.

Clinical Cardiology: New Frontiers

Treatment of Acute Ischemic Stroke

Part II: Neuroprotection and Medical Management

Joseph P. Broderick, MD; Werner Hacke, MD, PhD

From the Department of Neurology, University of Cincinnati College of Medicine, Cincinnati, Ohio (J.P.B.), and the University of Heidelberg, Department of Neurology, Heidelberg, Germany (W.H.).

Correspondence to Joseph P. Broderick, MD, Department of Neurology, University of Cincinnati College of Medicine, 231 Bethesda Ave, Cincinnati, OH 45267. E-mail joseph.broderick@ uc.edu

Key Words: stroke • ischemia • brain

An extract of the first 250 words of the full text is provided, because this article has no abstract.

	Introduction

 
Recanalization is the primary focus during the first hours after onset of ischemic stroke. However, preservation or neuroprotection of ischemic brain tissue by other means, prevention of stroke complications such as pneumonia and deep venous thrombosis, maximization of neural function of the surviving brain, and the start of therapies to prevent recurrent stroke are also important treatment goals. Part II of this review of acute stroke therapy focuses on these important elements of stroke care.

	Neuroprotection: Hypothermia as a Model Therapy

 
Neuroprotective agents have been extensively tested in randomized trials of acute ischemic stroke, and no agent has been proven effective, despite promising results in animal models.^1–3 The principle of neuroprotection after global brain ischemia, however, was recently demonstrated in 2 published trials of rapidly applied hypothermia in patients who had been resuscitated after cardiac arrest.^4,5 In an Australian study,⁴ 77 patients were randomly assigned to treatment with normothermia or hypothermia (core body temperature reduction to 33°C) within 2 hours after the return of spontaneous circulation and maintained at the temperature for 12 hours. Hypothermia was started in the field by the paramedics, and the core temperature was decreased by 1.4° during the first 120 minutes after restoration of spontaneous circulation. The odds ratio for a good outcome was 5.25 (95% confidence interval [CI] 1.47 to 18.76). There were no significant differences in the frequency of adverse events.

The second study randomized 275 patients who had been successfully resuscitated from a cardiac arrest to normothermia or hypothermia (32° to 34°C) over 24 hours.⁵ The median interval . . . [Full Text of this Article]

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