Abstract
Introduction: Many different factors may have an impact on clinical outcome after mechanical thrombectomy
(MT) for acute ischemic stroke (AIS). We aimed to investigate levels of serum glycemia
(GLY) within the first 48 hours after MT. Subjects and Methods: Consecutive AIS patients were enrolled in the retrospective bi-center study. Neurological
deficit was assessed with National Institutes of Health Stroke Scale (NIHSS) and functional
outcome after 3 months with modified Rankin scale with a score 0-2 for good outcome.
Presence of symptomatic intracerebral hemorrhage was assessed according to the SITS-
MOST criteria. Results: In total, 868 patients (442 males, mean age 69.7 ± 12.2 years) with a median of admission
NIHSS 17 points were enrolled in the study and 253 (29.1%) of them were diabetics.
Recanalization was reached in 758 (87.3%) patients. Patients with good outcome (412,
47.5%) had lower median of GLY (6.5 versus 7.4 mmol/L, P < .0001) within the first 48 hours after MT. Similar results were found also in diabetics
(8.1 versus 9.6 mmol/L, P < .0001) and in patients with achieved recanalization (6.5 versus 7.5 mmol/L, P < .0001). Multivariate regression analysis with adjustment for potential confounders
showed median of GLY (P = .0001, odds ratio: 0.830, 95% confidence interval: 0.755-0.913) as a predictor
of good outcome after MT. Conclusion: Lower levels of GLY within the first 48 hours after MT may be associated with better
functional outcome after 3 months.
Key Words
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Stroke and Cerebrovascular DiseasesAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Effects of admission hyperglycemia on mortality and costs in acute ischemic stroke.Neurology. 2002; 59: 67-71https://doi.org/10.1212/WNL.59.1.67
- Persistent poststroke hyperglycemia is independently associated with infarct expansion and worse clinical outcome.Stroke. 2003; 34: 2208-2214https://doi.org/10.1161/01.STR.0000085087.41330.FF
- Stroke project of the cerebrovascular diseases study group, Spanish society of neurology. The prognostic value of capillary glucose levels in acute stroke: the GLycemia in Acute Stroke (GLIAS) study.Stroke. 2009; 40: 562-568https://doi.org/10.1161/STROKEAHA.108.519926
- Stress hyperglycemia and prognosis of stroke in nondiabetic and diabetic patients: a systematic overview.Stroke. 2001; 32: 2426-2432
- Admission glucose level and clinical outcomes in the NINDS rt-PA stroke trial.Neurology. 2002; 59: 669-674https://doi.org/10.1212/WNL.59.5.669
- Effects of admission hyperglycemia on stroke outcome in reperfused tissue plasminogen activator–treated patients.Stroke. 2003; 34: 1235-1241https://doi.org/10.1161/01.STR.0000068406.30514.31
- Effects of glucose and PaO2 modulation on cortical intracellular acidosis, NADH redox state, and infarction in the ischemic penumbra.Stroke. 1999; 30: 160-170
- Hyperglycemia in acute ischemic stroke: a vascular perspective.J Cereb Blood Flow Metab. 2007; 27: 435-451
- A risk score to predict intracranial hemorrhage after recombinant tissue plasminogen activator for acute ischemic stroke.J Stroke Cerebrovasc Dis. 2008; 17: 331-333
- Predictors of good outcome after intravenous tPA for acute ischemic stroke.Neurology. 2001; 57: 474-480
- Older age does not increase risk of hemorrhagic complications after intravenous and/or intra-arterial thrombolysis for acute stroke.J Stroke Cerebrovasc Dis. 2008; 17: 266-272
- Persistent poststroke hyperglycemia is independently associated with infarct expansion and worse clinical outcome.Stroke. 2003; 34: 2208-2214
- Admission hyperglycemia and outcomes in large vessel occlusion strokes treated with mechanical thrombectomy.J Neurointerv Surg. 2018; 10: 112-117https://doi.org/10.1136/neurintsurg-2017-012993
- Effects of diabetes mellitus and admission glucose in patients receiving mechanical thrombectomy: a systematic review and meta-analysis.Neurocrit Care. 2018; https://doi.org/10.1007/s12028-018-0562-4
- Impact of glucose on outcomes in patients treated with mechanical thrombectomy: a post hoc analysis of the solitaire flow restoration with the intention for thrombectomy study.Stroke. 2016; 47: 120-127https://doi.org/10.1161/STROKEAHA.115.010753
- Glucose modifies the effect of endovascular thrombectomy in patients with acute stroke.Stroke. 2019; 50: 690-696https://doi.org/10.1161/STROKEAHA.118.023769
- Various blood glucose parameters that indicate hyper-glycemia after intravenous thrombolysis in acute ischemic stroke could predict worse outcome.PLoS One. 2014; 9: e94364
- Association of blood glucose and clinical outcome after mechanical thrombectomy for acute ischemic stroke.Intervent Neurol. 2018; 7: 182-188
- Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association.Stroke. 2018; 49: e46-e110https://doi.org/10.1161/STR.0000000000000158
- Trial design and reporting standards for intra-arterial cerebral thrombolysis for acute ischemic stroke.Stroke. 2003; 34: 109-137
- Multivariable analysis of outcome predictors and adjustment of main outcome results to baseline data profile in randomized controlled trials: Safe Implementation of Thrombolysis in Stroke-MOnitoring Study (SITS-MOST).Stroke. 2008; 39: 3316-3322
- American Heart Association Stroke Council; council on cardiovascular nursing; council on peripheral vascular disease; council on clinical cardiology. Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association.Stroke. 2013; 44: 870-947https://doi.org/10.1161/STR.0b013e318284056a
- Stress hyperglycemia and prognosis of stroke in nondiabetic and diabetic patients: a systematic overview.Stroke. 2001; 32: 2426-2432
- Management of hyperglycemia in acute stroke: how, when, and for whom?.Stroke. 2008; 39: 2177-2185
- Glucose-potassiuminsulin infusions in the management of post-stroke hyperglycaemia: the UK Glucose Insulin in Stroke Trial (GIST-UK).Lancet Neurol. 2007; 6: 397-406https://doi.org/10.1016/S1474-4422(07)70080-7
- Randomized, controlled trial of insulin for acute poststroke hyperglycemia.Ann Neurol. 2010; 67: 570-578https://doi.org/10.1002/ana.21983
- Insulin for glycaemic control in acute ischemic stroke.Cochrane Database Syst Rev. 2014; https://doi.org/10.1002/14651858.CD005346.pub4
- Intensive vs standard treatment of hyperglycemia and functional outcome in patients with acute ischemic stroke.JAMA. 2019; 322: 326-335https://doi.org/10.1001/jama.2019.9346
- Hyperglycemia during ischemia rapidly accelerates brain damage in stroke patients treated with tPA.J Cereb Blood Flow Metab. 2007; 27: 1616-1622
- Clinical outcome after mechanical thrombectomy in patients with diabetes with major ischemic stroke of the anterior circulation.World Neurosurg. 2018; 120: e212-e220https://doi.org/10.1016/j.wneu.2018.08.032
- Risk factors of intracranial hemorrhage after mechanical thrombectomy of anterior circulation ischemic stroke.Neuroradiology. 2019; (Epub 18 February 2019)https://doi.org/10.1007/s00234-019-02180-6
- Increased blood-brain barrier permeability and altered tight junctions in experimental diabetes in the rat: contribution of hyperglycaemia and matrix metalloproteinases.Diabetologia. 2007; 50: 202-211
- Influence of hyperglycemia on oxidative stress and matrix metalloproteinase-9 activation after focal cerebral ischemia/reperfusion in rats: relation to blood-brain barrier dysfunction.Stroke. 2007; 38: 1044-1049
Article info
Publication history
Published online: January 24, 2020
Accepted:
December 21,
2019
Received in revised form:
November 20,
2019
Received:
August 22,
2019
Identification
DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2019.104621
Copyright
© 2019 Elsevier Inc. All rights reserved.
