Persistent middle cerebral artery occlusion associated with lower body temperature on admission

Abstract

Christopher Elnan Kvistad,1 Halvor Øygarden,1 Lars Thomassen,1 Ulrike Waje-Andreassen,1 Halvor Naess1,21Department of Neurology, Haukeland University Hospital, Bergen, Norway; 2Centre for age-related medicine, Stavanger University Hospital, Stavanger, NorwayBackground: Low body temperature is considered neuroprotective in ischemic stroke, yet some studies suggest that low body temperature may also inhibit clot lysis and recanalization. We hypothesized that low body temperature was associated with persistent proximal middle cerebral artery (MCA) occlusion in patients with acute ischemic stroke presenting with symptoms of proximal MCA occlusion, suggesting a possible detrimental effect of low body temperature on recanalization.Methods: All patients with acute ischemic stroke admitted to our Stroke Unit between February 2006 and August 2012 were prospectively registered in a database. Computed tomography (CT) angiography was performed in patients admitted <6 hours after stroke onset. Based on presenting symptoms, patients were classified according to the Oxford Community Stroke Project classification (OCSP). Patients with symptomatic proximal MCA occlusion were compared to patients with total anterior circulation infarct (TACI) without MCA occlusion on CT angiography.Results: During the study period, 384 patients with acute ischemic stroke were examined with CT angiography. A total of 79 patients had proximal MCA occlusion and 31 patients had TACI without MCA occlusion. Median admission body temperatures were lower in patients with MCA occlusion compared to patients without occlusion (36.3°C versus 36.7°C, P = 0.027). Admission body temperature <36.5°C was independently associated with persistent MCA occlusion when adjusted for confounders in multivariate analyses (odds ratio 3.7, P = 0.007).Conclusion: Our study showed that low body temperature on admission was associated with persistent proximal MCA occlusion. These results may support a possible detrimental effect of low body temperature on clot lysis and recanalization.Keywords: body temperature, clot lysis, ischemic stroke, MCA occlusion