on March 10, 2005
Published online before print March 10, 2005, doi: 10.1161/01.STR.0000158914.66827.2e
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Submitted on December 13, 2004
From the Departments of Neurology (A.B.S., W.J.K., F.S.B.) and Radiology (T.B., L.R., P.W.S., E.H.L., R.G.G., A.G.S.), Massachusetts General Hospital and Harvard Medical School, Boston, Mass. * To whom correspondence should be addressed. E-mail: asinghal{at}partners.org.
Background and Purpose--Therapies that transiently prevent ischemic neuronal death can potentially extend therapeutic time windows for stroke thrombolysis. We conducted a pilot study to investigate the effects of high-flow oxygen in acute ischemic stroke. Methods--We randomized patients with acute stroke (<12 hours) and perfusion-diffusion "mismatch" on magnetic resonance imaging (MRI) to high-flow oxygen therapy via facemask for 8 hours (n=9) or room air (controls, n=7). Stroke scale scores and MRI scans were obtained at baseline, 4 hours, 24 hours, 1 week, and 3 months. Clinical deficits and MR abnormalities were compared between groups. Results--Stroke scale scores were similar at baseline, tended to improve at 4 hours (during therapy) and 1 week, and significantly improved at 24 hours in hyperoxia-treated patients. There was no significant difference at 3 months. Mean (±SD) relative diffusion MRI lesion volumes were significantly reduced in hyperoxia-treated patients at 4 hours (87.8±22% versus 149.1±41%; P=0.004) but not subsequent time points. The percentage of MRI voxels improving from baseline "ischemic" to 4-hour "non-ischemic" values tended to be higher in hyperoxia-treated patients. Cerebral blood volume and blood flow within ischemic regions improved with hyperoxia. These "during-therapy" benefits occurred without arterial recanalization. By 24 hours, MRI showed reperfusion and asymptomatic petechial hemorrhages in 50% of hyperoxia-treated patients versus 17% of controls (P=0.6). Conclusions--High-flow oxygen therapy is associated with a transient improvement of clinical deficits and MRI abnormalities in select patients with acute ischemic stroke. Further studies are warranted to investigate the safety and efficacy of hyperoxia as a stroke therapy.
Revised on January 11, 2005
Accepted on January 12, 2005
A Pilot Study of Normobaric Oxygen Therapy in Acute Ischemic Stroke
Aneesh B. Singhal MD*;
Key words: magnetic resonance imaging • neuroprotection • oxygen • stroke
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