Beneficial Effect of Hypothermia Plus Hemicraniectomy Compared With Hemicraniectomy
Beneficial Effect of Hypothermia Plus Hemicraniectomy Compared With Hemicraniectomy
To study safety and feasibility of mild therapeutic hypothermia after decompressive
 hemicraniectomy compared with hemicraniectomy alone in patients with malignant cerebral
 infarction
The current clinical trial is an investigator-initiated one, and it is conducted under the
 multi-center, single arm, open-label, prospective design. The subject meeting
 inclusion/exclusion criteria will be assigned to treatment group.

 The subjects of treatment group should be initiated hypothermia therapy as soon as possible
 after surgery (less than 6 hours). It can be duration at least 72 hours according to subject
 status. Also process of recovery temperature period will be allowed within 20-40 hours. After
 6 month, 12 month of the onset of symptom, mRS score are measured. This is followed by
 closure of clinical trial.
Inclusion Criteria:

 A. Written informed consent obtained from the patient or his/her legally acceptable
 representative B. Acute ischemic stroke within middle cerebral artery or internal carotid
 artery occlusion

 -  Regardless of anterior cerebral artery (ACA) or posterior cerebral artery (PCA)
 involvement C. Patients of both sexes aged ≥ 19 years and ≤ 82 years D. NIHSS score ≥
 15 points, NIHSS loss of consciousness 1a score ≥ 1 point E. Patients with proximal
 cerebral arterial occlusion (such as middle cerebral or internal carotid artery) F.
 Unilateral ischemic lesion of at least 2/3 of the middle cerebral artery (MCA)
 territory involving basal ganglia confirmed by computed tomography (CT) or magnetic
 resonance imaging (MRI)

 -  Decided to perform decompressive hemicraniectomy within 48 hours after symptom onset -
 Onset time was defined as the time when patients were lastly seen normal

 Exclusion Criteria:

 A. Premorbid modified Rankin Scale (mRS) score ≥ 2 B. Presence of other type of brain
 lesions including traumatic brain injury, contralateral or infratentorial infarct.

 C. Absence of bilateral pupillary reflex D. Known bleeding disorder or coagulopathy E.
 Sepsis F. End stage malignant disease G. Pregnancy or during breast feeding H. Life
 expectancy less than 3 year