Have your competent? doctor and hospital initiate research that finishes the job and delivers 100% recovery protocols! Why can't that be done?
Laziness? Incompetence? Or just don't care? NO leadership? NO strategy? Not my job? Not my Problem!
Targeted Brain Cooling Boosts LVO Recovery After Thrombectomy
Targeted cooling to the brain during endovascular thrombectomy significantly improved functional outcomes in patients with large-vessel occlusion ischemic stroke.
Results of the CHILL-ART trial showed that cooling the brain by infusion of saline chilled to 4 °C led to a substantial increase in the number of patients who achieved a favorable functional outcome at 90 days.(Favorable to survivors is 100% RECOVERY; not your tyranny of low expectations where failure is considered success!)
“Even when we successfully remove the clot, many patients do not regain independence because of ongoing brain injury after blood flow is restored,” said principal investigator Zhi-Xin Huang, MD, Guangdong Second Provincial General Hospital of Jinan University, Guangzhou, China.(Yeah, that's called the neuronal cascade of death and will kill off hundreds of millions of neurons in the first week! I'd suggest billing your doctors and hospital $1000 a dead neuron, that would concentrate their minds!)
“Our findings show that targeted cooling delivered directly into the brain at the moment of reperfusion can meaningfully improve recovery without adding risk,” he noted.
A second trial of a similar technique, FOCUS, also conducted in China, did not show a significant benefit, but functional outcomes trended in a positive direction in the intervention group, and there was a safety benefit with a reduction of any intracerebral hemorrhage (ICH) incidence at 24 hours.
“These findings validate the feasibility of selective intra-arterial cooling as an adjunctive therapy during endovascular thrombectomy. The marked decrease in any intracerebral hemorrhage indicates a potential protective effect on the blood-brain barrier and microvasculature, which may translate into clinical benefits,” FOCUS investigator, Shen Li, MD, Beijing Shijitan Hospital, Beijing, China, said.
The findings from both studies were presented on May 6 at the European Stroke Organization Conference (ESOC) 2026.
A Novel Approach
The CHILL-ART trial investigator, Raul Nogueira, MD, University of Pittsburgh School of Medicine, Pittsburgh, explained that hypothermia is known to be an effective neuroprotectant.
He noted that substantial data support the concept, but implementation has remained challenging. Systemic hypothermia has been associated with several drawbacks: It takes time to induce, can disrupt endovascular treatment workflows, and has been linked to significant adverse effects, including higher rates of pulmonary infection, potential coagulopathy and bleeding complications, and refractory shivering. As a result, this approach has not been widely pursued.
The CHILL-ART and FOCUS trials investigated a novel approach of inducing regional hypothermia by infusing chilled saline intra-arterially directly into the brain at the end of the thrombectomy procedure.
The intervention uses standard thrombectomy equipment and refrigerated saline, making it readily scalable in routine clinical practice without requiring specialized devices or additional training.
The CHILL-ART trial enrolled 262 patients across 26 comprehensive stroke centers. Participants within 24 hours of stroke onset were randomized to receive either thrombectomy plus intra-arterial infusion of 350 ml of cold saline (hypothermia group) or thrombectomy with room-temperature saline (control group). The saline was administered at 50ml pre-reperfusion and 300 ml directly after reperfusion.
The median patient age was 70 years, and the median National Institutes of Health Stroke Scale score was 14. The trial imposed no exclusion criteria based on baseline ASPECTS, and patients could be enrolled up to 24 hours after stroke onset. However, the median ASPECTS was high at 8, and treatment was initiated fairly early, at a median of between 5 and 6 hours after stroke onset, Nogueira reported.
15% Absolute Increase in Functional Independence
The study’s primary outcome, functional independence defined as a modified Rankin Scale (mRS) score of 0-2 at 90 days, was achieved in 54.7% of patients in the hypothermia group compared with 39.8% in the control group (adjusted risk ratio, 1.36; 95% CI, 1.05 1.76; P =.018). This gives a number need to treat for one additional favorable outcome of 7.
Safety outcomes were comparable between groups, with no significant increase in symptomatic ICH (7.0% vs 9.0%) or 90-day mortality (13.3% vs 18.0%).
By combining reperfusion with targeted neuroprotection, the study introduces a promising new approach into acute stroke treatment, and these findings support broader adoption of intra-arterial hypothermia as an accessible, cost-effective strategy to reduce disability after stroke, the CHILL-ART trial investigators concluded.
However, the FOCUS trial results were not as favorable. The trial, conducted at 12 hospitals, enrolled 258 patients with anterior circulation large-vessel occlusion stroke who presented within 24 hours of symptom onset. Participants were randomized to receive either selective intra-arterial cooling plus endovascular thrombectomy or standard thrombectomy alone.
Results showed no significant difference in functional outcomes at 90 days between the two groups, with an adjusted common odds ratio of 1.16 (95% CI, 0.75-1.79; P = .51).
However, the safety results were encouraging, with a reduction in ICH rates in the cooling group with an adjusted risk difference of -0.174 (95% CI, -0.288 to -0.059; P = .003). There was no difference in the occurrence of symptomatic ICH or mortality between groups.
Easy and Inexpensive
Noguera pointed out that this approach is easy and inexpensive.
“We can use the typical neurovascular thrombectomy equipment, and it’s very easy to implement. You just need cold saline at 4 degrees,” he said.
Nogueira added that the results of the two studies were not necessarily contradictory, noting that both were only moderately sized trials. He suggested that the benefit seen in the CHILL-ART trial — a 15% absolute improvement in functional independence — was larger than expected, whereas the FOCUS trial produced more modest results than investigators had hoped for.
However, he noted that the mRS shift analyses from the two studies were actually similar, suggesting the apparent discrepancy may reflect differences in statistical power and sample size rather than fundamentally different findings.
“We are going to need more trials, larger numbers, and potentially meta-analyses, to really answer this question,” he said.
Still, Nogueira argued that the studies together provide important validation of the concept. “While we are going to need more data before changing guidelines, I think we have validated this concept here, and it is definitely a big step in the right direction,” he commented.
He added that regional brain cooling should now become a major focus of thrombectomy research because of its simplicity and apparent promise.
“I would say this regional cooling approach should be the biggest priority in thrombectomy research now because it’s so easy to implement, and we have a very strong signal of effectiveness,” Nogueira said.
Large Therapeutic Effect
Commenting on the CHILL-ART trial, Marieta Peycheva, MD, Medical University of Plovdiv, Plovdiv, Bulgaria, characterized the findings as “really amazing.”
She asked about safety, noting that there appeared to be slight increase in pneumonia in the intervention group.
Nogueira replied that the safety appears very good. He pointed out that rates of symptomatic ICH and mortality were numerically lower in the hypothermia groups in both trials, which he said was encouraging from a neurologic safety perspective.
Although pneumonia occurred slightly more often among patients receiving hypothermia, he emphasized that the cooling strategy produced minimal systemic effects because it was delivered over only a brief period rather than inducing prolonged whole-body hypothermia.
“Of course we need to look at that carefully in the future, but I think overall, in both trials we saw the same direction towards a benefit and very good safety.”
Commenting on the CHILL-ART trial, Peter Kelly, MD, University College Dublin, Dublin, Ireland, said the study really stood out.
“It showed a big therapeutic effect — a 15% absolute benefit in terms of 90-day functional independence, it looked very safe, and it involved just cooling a bag of saline to 4 °C.”
“This should certainly kick off a whole collection of new trials to try to confirm those really interesting results,” he added.
Both trials were investigator initiated. The authors reported having no relevant disclosures.
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