COR amended to conform with ACC/AHA 2015 Recommendation Classification System. The data on the use of hypothermia and barbiturates for the management of AIS continue to be limited. Such data include only studies with small numbers of patients and unclear timing of intervention with respect to stroke onset. Hypothermia use has recently been shown to have no impact on stroke outcomes in a meta-analysis of 6 RCTs.286 Further trials are necessary to clarify the safety and efficacy of this intervention. See Tables LXIX and LXX in online Data Supplement 1. 4.12. Rehabilitation (Continued) COR LOE New, Revised, or Unchanged Powers et al 2019 Guidelines for Management of AIS e387 Because of a lack of evidence of efficacy and the potential to increase the risk of infectious complications, corticosteroids (in conventional or large doses) should not be administered for the treatment of brain swelling complicating ischemic stroke. III: Harm A Recommendation wording modified from 2013 AIS Guidelines to match COR III stratifications. LOE unchanged. COR amended to conform with ACC/AHA 2015 Recommendation Classification System. 5.1.3. Surgical Management-Supratentorial Infarction COR LOE New, Revised, or Unchanged Although the optimal trigger for decompressive craniectomy is unknown, it is reasonable to use a decrease in level of consciousness attributed to brain swelling as selection criteria. IIa A Recommendation, COR, and LOE unchanged from 2014 Brain Swelling. In patients 60 years of age who deteriorate neurologically within 48 hours from brain swelling associated with unilateral MCA infarctions despite medical therapy, decompressive craniectomy with dural expansion is reasonable. IIa A Recommendation revised from 2014 Brain Swelling. 