ABSTRACT NUMBER: ESOC2026A818 THE HOMEOSTASIS-BASED PROTOCOL TO FREEZE PENUMBRA IN ISCHEMIC STROKE PATIENTS

Abstract Background and aims The use of reperfusion therapies is ineffective in almost half of the acute ischemic stroke (AIS) patients. Maintaining homeostasis and cytoprotection is a rational starting point for developing a bundle of interventions to improve AIS outcomes. Methods We provide the protocol (“TAKE 5”) that integrates several approaches: optimizing body temperature, maintaining water balance to achieve an optimal mean arterial pressure (MAP), ensuring metabolic and ionic homeostasis, and providing cytoprotection. Results Several studies provide evidence supporting “TAKE 5” protocol: 1/stabilization of the body temperature. A robust meta-analysis indicates that paracetamol given to patients with AIS is safe and reduces early mortality, 2/restoration of the water balance and stable MAP. Higher MAP lowers the NIHSS (7 points for each 10mmHg up to 90mmHg). Considering the correlation with vascular measures, one may tend to use MAP=[DBP]+0.412×[PP] formula that we compared with the other formulas. 3/Metabolic stabilization i.e. optimal glycemia. 4/Correction of magnesium depletion using MgSO4. It is safe, potentially beneficial, and can be easily added to buffered crystalloids to correct fluid deficits. 5/Cytoprotection protects against or reduce the consequences of reperfusion injury and improves treatment outcomes. Cerebrolysin is a preparation with potential cytoprotective action and supports the neurorehabilitation of patients in the AIS. We present the clinical improvement in patients with Cerebrolysin as add-on to reperfusion. Conclusions The Homeostasis-Based Protocol (“TAKE5”) can be successfully applied in all AIS patients, particularly during the pre-recanalization phase (before/during transportation to the thrombectomy center) or directly after reperfusion therapy. Conflict of interest Slawomir Michalak.nothing to disclose. Michal Karlinski.nothing to disclose. Jacek staszewski.nothing to disclose.