Feasibility and safety of vertebrobasilar artery cooling infusion (VACI) following thrombectomy for acute posterior circulation ischemic stroke: A pilot randomized controlled trial

Not all patients with acute ischemic stroke (AIS) benefit from endovascular therapy (EVT), particularly in the posterior circulation. This pilot randomized controlled trial evaluated the safety, feasibility, and preliminary efficacy of vertebrobasilar artery cooling infusion (VACI) administered after successful recanalization as a neuroprotective strategy for posterior circulation AIS. Participants were randomly assigned (1:1) to VACI or control. The VACI group received 300 mL of 4 °C saline infused into the vertebral artery at 30 mL/min after thrombectomy, whereas controls received 300 mL of 37 °C saline. All patients received standard guideline-based care. The primary endpoint was symptomatic intracranial hemorrhage (sICH). Secondary endpoints included functional outcomes, infarct volume, mortality, intracranial hemorrhage (ICH), vasospasm, coagulation abnormalities, pneumonia, and urinary tract infection. VACI following EVT appears safe and feasible in posterior circulation AIS and may offer potential neuroprotective benefit. Forty patients were enrolled and analyzed. The incidence of sICH did not differ between groups. Rates of neurological deterioration and other complications were comparable. Favorable trends were observed in the VACI group, including improved early neurological recovery (median NIHSS 6 vs. 12.5) and smaller final infarct volume (9.0 vs. 17.5 mL). Mortality was numerically lower in the VACI group at 90 days (10.0% vs. 20.0%) and at 7 days (5.0% vs. 20.0%). Although differences were not statistically significant, outcomes consistently favored VACI. VACI following EVT appears safe and feasible in posterior circulation AIS and may offer potential neuroprotective benefit.