Reader Response: Normobaric Hyperoxia Combined With Endovascular Treatment for Patients With Acute Ischemic Stroke: A Randomized Controlled Clinical Trial

We read with interest the results of this randomized clinical trial, which shows that normobaric hyperoxia combined with endovascular treatment is safe, could reduce infarct volume, and improve clinical outcomes in patients with acute ischemic stroke compared with patients who received only endovascular treatment.1 The authors are to be commended on successfully leveraging such a pragmatic treatment. It is of importance that these findings stand in stark contrast to the Stroke Oxygen Study, which found no benefit of supplemental oxygen (2–3 L/min) in patients with acute stroke.2 While there were no consistent effects of hyperoxemia across exploratory subgroups of the 8,003 patients in the Stroke Oxygen trial, including the subgroup with acute ischemic stroke (n = 6,334), there was a trend suggesting benefit of hyperoxia in patients with more severe deficits, which indicates possible acute large vessel occlusion. Patients with a baseline NIHSS of 15–20 were nonsignificantly at greater odds of achieving a better 90-day functional outcome with supplemental oxygen (OR 1.28, 95% CI 0.94–1.73) when compared with patients with lower NIHSS (e.g., NIHSS 0–4 OR 0.94, 95% CI 0.83–1.07).