Successful Management of Massive Anterior-Middle Cerebral Artery Territory Stroke with Catheter-Based Heat Exchange System
Elevated temperature is commonly accompanied with severe neurological damage and its management is the key for improving the outcome. Herein we report a 77-year-old man who presented with altered consciousness and left hemiplegia at awakening. The magnetic resonance image on arrival showed right internal carotid artery occlusion and massive completed infarction in anterior and middle cerebral artery territories. He underwent temperature management with catheter-based heat exchange system targeting at 36 degrees Celsius of core temperature for 7 days by local anesthesia. The target temperature was obtained in 4 hours from installation. The core temperature was stably maintained without shivering, discomfort or other adverse effects. The brain edema was not as severe as decompressive craniectomy was required. He gradually recovered consciousness and discharged to the rehabilitation facility with left hemiplegia in modified Rankin Scale of 4. Catheter-based heat exchange enables to acquire target temperature automatically in a short time and could minimize the brain edema after brain damage with safety and feasibility.