Clinical outcomes associated with mild hypothermia therapy after mechanical thrombectomy for acute large anterior circulation infarction with large infarct Core: A non-contrast CT-Based imaging and functional outcome study

Background The clinical efficacy and safety of combining mild hypothermia therapy with mechanical thrombectomy in patients with acute large anterior circulation infarction remain unclear, particularly regarding CT imaging characteristics. Methods Patients with acute large anterior circulation infarction who underwent mechanical thrombectomy alone or combined with mild hypothermia between June 2024 and April 2025 were retrospectively enrolled and divided into control (n = 60) and study (n = 60) groups. Serial non-contrast CT (NCCT) was qualitatively assessed at baseline, 24 h, and 48 h post-reperfusion for hypodensity, mass effect, and edema progression. Apparent diffusion coefficient (ADC) and relative ADC (rADC) were quantitatively measured at 72 h and 2 weeks. Clinical outcomes included National Institutes of Health Stroke Scale (NIHSS), Barthel Index (BI), 3-month modified Rankin Scale (mRS) favorable outcome, and complications. Results On NCCT, more confined hypodense areas and less apparent progression of edema and mass effect at 24 and 48 h compared with the control group, representing qualitative descriptive imaging findings. At 72 h, the study group showed significantly higher ADC and BI values and lower NIHSS scores than the control group (all P < 0.05), whereas the between-group difference in rADC was not statistically significant (P = 0.079). At 2 weeks, the study group showed significantly higher ADC, rADC, and BI values and lower NIHSS scores than the control group (all P < 0.05). At 3 months, the study group had a higher rate of favorable outcome (66.67% vs. 30.00%, P < 0.001). Mortality and major complications did not differ significantly (all P > 0.05). Multivariate analysis showed that mild hypothermia was significantly associated with 90-day functional outcome, with lower odds of unfavorable outcome (OR 0.066, 95%CI 0.019-0.235, P < 0.001). Conclusion Adjunctive mild hypothermia was associated with less infarct progression and edema, relatively preserved ADC/rADC, and better functional outcomes. Prospective randomized studies are needed to confirm these findings.