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Fuller E, Vivanco-Suarez J, Fain NH, Zevallos CB, Lu Y, Ortega-Gutierrez S, Derdeyn C. Predictors of tissue infarction from distal emboli after mechanical thrombectomy. J Neurointerv Surg 2024; 16:959-965. [PMID: 37620130 DOI: 10.1136/jnis-2023-020782] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 08/11/2023] [Indexed: 08/26/2023]
Abstract
BACKGROUND Distal embolization after endovascular thrombectomy (EVT) is common. We aimed to determine factors associated with tissue infarction in the territories of distal emboli. METHODS This is a retrospective cohort study of consecutive patients with anterior circulation large vessel occlusions who underwent EVT from 2015 to 2021. Patients with Thrombolysis In Cerebral Infarction (TICI) 2b reperfusion and follow-up imaging were identified. Baseline characteristics, procedural details, and imaging findings were reviewed. Primary outcome was categorized according to the occurrence of infarction at the territory of distal embolus on follow-up diffusion-weighted imaging MRI. RESULTS Of 156 subjects, 97 (62%) had at least one infarction in the territories at risk. Hypertension was significantly more prevalent in the infarct group (83% vs 53%, P=0.001). General anesthesia was more commonly used in the infarct group (60% vs 43%, P=0.037). The median number of distal emboli and diameter of the occluded vessel were similar. After adjusting for confounders, hypertension (aOR 4.73, 95% CI 1.81 to 13.25, P=0.002), higher blood glucose (aOR 1.01, 95% CI 1.00 to 1.03, P=0.023), and general anesthesia (aOR 2.75, 95% CI 1.15 to 6.84, P=0.025) were independently associated with infarction. The presence of angiographic leptomeningeal collaterals predicted tissue survival (aOR 0.13, 95% CI 0.05 to 0.33, P<0.001). 90-day modified Rankin scale (mRS) scores were worse for the infarction patients (mRS 0-2: infarct, 39% vs 55%, P=0.046). CONCLUSIONS Nearly 40% of patients with TICI 2b had no tissue infarction in the territory of a distal embolus. The association of infarction with hypertension and general anesthesia suggests late or post-procedural blood pressure management could be a modifiable factor. Patients with poor leptomeningeal collaterals or hyperglycemia may benefit from further attempts at revascularization.
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Affiliation(s)
- Emily Fuller
- Carver College of Medicine, The University of Iowa Roy J and Lucille A Carver College of Medicine, Iowa City, Iowa, USA
| | - Juan Vivanco-Suarez
- Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Nicholas H Fain
- Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Cynthia B Zevallos
- Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Yujing Lu
- Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Santiago Ortega-Gutierrez
- Department of Neurology, Neurosurgery, and Radiology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Colin Derdeyn
- Department of Neurology, Neurosurgery, and Radiology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
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Kimura R, Suzuki K, Saito T, Katano T, Nishiyama Y, Kimura K. Hyperglycemia and Outcomes in Patients with Successful Reperfusion by Mechanical Thrombectomy. Intern Med 2024; 63:2385-2390. [PMID: 38296481 DOI: 10.2169/internalmedicine.2626-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/03/2024] Open
Abstract
Objective This study examined whether or not hyperglycemia on admission is associated with poor outcomes in patients with successful reperfusion by mechanical thrombectomy (MT). Methods Consecutive patients with acute anterior circulation stroke and large-vessel occlusion treated with MT were evaluated. Hyperglycemia was defined as a blood glucose level of >140 mg/dL on admission. Successful reperfusion was defined as Thrombolysis in Cerebral Infarction of grade 2b or 3. A poor clinical outcome 90 days after the onset was defined as a modified Rankin Scale score of 4-6. We compared characteristics, including outcomes, between the normoglycemic (≤140 mg/dL) and hyperglycemic groups. In addition, the association between hyperglycemia and outcomes was evaluated in patients with successful reperfusion using MT. Results The participants comprised 407 patients [median age, 76.5 years old; 58.0% men; median National Institutes of Health Stroke Scale (NIHSS) score, 17]. The site of occlusion was the Internal Carotid Artery (ICA) in 119 patients (29.2%) and the M1 in 178 patients (43.7%). Normoglycemia, hyperglycemia, successful reperfusion, and poor outcomes were found in 138 (33.9%), 269 (66.1%), 320 (78.6%), and 141 (34.4%) patients, respectively. Poor outcomes were more frequent in hyperglycemic patients (61.6%) than in normoglycemic patients (43.9%, p=0.001). Among patients with successful reperfusion, poor outcomes were more frequent in hyperglycemic patients (57.8%) than in normoglycemic patients (37.9%; p<0.001). In patients with successful reperfusion, a multivariate regression analysis identified hyperglycemia as a factor associated with poor outcomes (odds ratio, 2.151; confidence interval, 1.166-3.970; p=0.014). Conclusion Among all patients, hyperglycemia on admission was associated with a poor outcome in those treated with MT. Regarding the presence of successful reperfusion by MT, patients with successful reperfusion had such effects.
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Affiliation(s)
| | | | | | | | | | - Kazumi Kimura
- Department of Neurology, Nippon Medical School, Japan
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3
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Hervás C, Peirotén I, González L, Alonso de Leciñana M, Alonso-López E, Casado L, De Celis-Ruíz E, Fernández Prieto AF, Frutos R, Gallego-Ruiz R, González Pérez de Villar N, Gutiérrez-Fernández M, Navia P, Otero-Ortega L, Pozo-Novoa J, Rigual R, Rodríguez-Pardo J, Ruiz G, Fuentes B. Glycaemia and ischaemia-reperfusion brain injury in patients with ischaemic stroke treated with mechanical thrombectomy (GLIAS-MT): an observational, unicentric, prospective study protocol. BMJ Open 2024; 14:e086745. [PMID: 39117402 PMCID: PMC11404171 DOI: 10.1136/bmjopen-2024-086745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/10/2024] Open
Abstract
INTRODUCTION Poststroke hyperglycaemia is an independent risk factor for poorer outcomes in patients treated with mechanical thrombectomy (MT) and is associated with a lower probability of functional recovery and higher mortality at 3 months. This study aims to evaluate the association between glucose levels during cerebral reperfusion with MT and functional recovery at 3 months, measured by subcutaneous continuous glucose monitoring (CGM) devices. METHODS This prospective observational study aims to recruit 100 patients with ischaemic stroke and large anterior circulation vessel occlusion, in whom MT is indicated. CGM will be performed using a Freestyle Libre ProIQ device (FSL-CGM, Abbott Diabetes Care, Alameda, California, USA), which will be implanted on admission to the emergency department, to monitor glucose levels before, during and after reperfusion. The study's primary endpoint will be the functional status at 3 months, as measured by the dichotomised modified Rankin Scale (0-2 indicating good recovery and 3-6 indicating dependency or death). We will analyse expression profiles of microRNA (miRNA) at the time of reperfusion and 24 hours later, as potential biomarkers of ischaemic-reperfusion injury. The most promising miRNAs include miR-100, miR-29b, miR-339, miR-15a and miR-424. All patients will undergo treatment according to current international recommendations and local protocols for the treatment of stroke, including intravenous thrombolysis if indicated. ETHICS AND DISSEMINATION This study (protocol V.1.1, dated 29 October 2021, code 6017) has been approved by the Clinical Research Ethics Committee of La Paz University Hospital (Madrid, Spain) and has been registered in ClinicalTrials.gov (NCT05871502). Study results will be disseminated through peer-reviewed publications in Open Access format and at conference presentations. TRIAL REGISTRATION NUMBER NCT05871502.
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Affiliation(s)
- Carlos Hervás
- Department of Neurology and Stroke Centre, La Paz University Hospital and Department of Medicine, Universidad Autónoma de Madrid, La Paz University Hospital Research Institute (IdiPAZ), Madrid, Spain
| | - Irene Peirotén
- Department of Neurology and Stroke Centre, La Paz University Hospital and Department of Medicine, Universidad Autónoma de Madrid, La Paz University Hospital Research Institute (IdiPAZ), Madrid, Spain
| | - Laura González
- Department of Neurology and Stroke Centre, La Paz University Hospital and Department of Medicine, Universidad Autónoma de Madrid, La Paz University Hospital Research Institute (IdiPAZ), Madrid, Spain
| | - María Alonso de Leciñana
- Department of Neurology and Stroke Centre, La Paz University Hospital and Department of Medicine, Universidad Autónoma de Madrid, La Paz University Hospital Research Institute (IdiPAZ), Madrid, Spain
| | - Elisa Alonso-López
- Department of Neurology and Stroke Centre, La Paz University Hospital and Department of Medicine, Universidad Autónoma de Madrid, La Paz University Hospital Research Institute (IdiPAZ), Madrid, Spain
| | - Laura Casado
- Department of Neurology and Stroke Centre, La Paz University Hospital and Department of Medicine, Universidad Autónoma de Madrid, La Paz University Hospital Research Institute (IdiPAZ), Madrid, Spain
| | - Elena De Celis-Ruíz
- Department of Neurology and Stroke Centre, La Paz University Hospital and Department of Medicine, Universidad Autónoma de Madrid, La Paz University Hospital Research Institute (IdiPAZ), Madrid, Spain
| | - Andrés Francisco Fernández Prieto
- Department of Radiology (Neurointerventional Radiology), La Paz University Hospital, La Paz University Hospital Research Institute (IdiPAZ), Madrid, Spain
| | - Remedios Frutos
- Department of Radiology (Neurointerventional Radiology), La Paz University Hospital, La Paz University Hospital Research Institute (IdiPAZ), Madrid, Spain
| | - Rebeca Gallego-Ruiz
- Neurological Sciences and Cerebrovascular Research Laboratory, La Paz University Hospital Research Institute (IdiPAZ), Madrid, Spain
| | - Noemí González Pérez de Villar
- Diabetes Unit, Department of Endocrinology, La Paz University Hospital, La Paz University Hospital Research Institute (IdiPAZ), Madrid, Spain
| | - María Gutiérrez-Fernández
- Neurological Sciences and Cerebrovascular Research Laboratory, La Paz University Hospital Research Institute (IdiPAZ), Madrid, Spain
| | - Pedro Navia
- Department of Radiology (Neurointerventional Radiology), La Paz University Hospital, La Paz University Hospital Research Institute (IdiPAZ), Madrid, Spain
| | - Laura Otero-Ortega
- Neurological Sciences and Cerebrovascular Research Laboratory, La Paz University Hospital Research Institute (IdiPAZ), Madrid, Spain
| | - Javier Pozo-Novoa
- Neurological Sciences and Cerebrovascular Research Laboratory, La Paz University Hospital Research Institute (IdiPAZ), Madrid, Spain
| | - Ricardo Rigual
- Department of Neurology and Stroke Centre, La Paz University Hospital and Department of Medicine, Universidad Autónoma de Madrid, La Paz University Hospital Research Institute (IdiPAZ), Madrid, Spain
| | - Jorge Rodríguez-Pardo
- Department of Neurology and Stroke Centre, La Paz University Hospital and Department of Medicine, Universidad Autónoma de Madrid, La Paz University Hospital Research Institute (IdiPAZ), Madrid, Spain
| | - Gerardo Ruiz
- Department of Neurology and Stroke Centre, La Paz University Hospital and Department of Medicine, Universidad Autónoma de Madrid, La Paz University Hospital Research Institute (IdiPAZ), Madrid, Spain
| | - Blanca Fuentes
- Department of Neurology and Stroke Centre, La Paz University Hospital and Department of Medicine, Universidad Autónoma de Madrid, La Paz University Hospital Research Institute (IdiPAZ), Madrid, Spain
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Pan H, Xiong Y, Huang Y, Zhao J, Wan H. Association between stress hyperglycemia ratio with short-term and long-term mortality in critically ill patients with ischemic stroke. Acta Diabetol 2024; 61:859-868. [PMID: 38499778 DOI: 10.1007/s00592-024-02259-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Accepted: 02/11/2024] [Indexed: 03/20/2024]
Abstract
AIMS Hyperglycemia on admission is associated with poor prognosis in ischemic stroke (IS) patients. We aimed to investigate the relationship between stress hyperglycemia ratio (SHR) and short-term or long-term mortality in IS patients in the ICU and to explore whether this relationship is influenced by diabetes status. MATERIALS AND METHODS We collected patients with severe IS requiring ICU admission in the Medical Information Mart for Intensive Care (MIMIC-IV) database and calculated SHR. Outcomes included 30-day, 90-day, and 1-year mortality. The association between SHR and mortality in patients with critical IS was elucidated using Multivariate Cox regression and subgroup analysis for diabetes. RESULTS A total of 1376 patients were recruited. After adjusting for potential confounders, patients in the third and fourth quartiles had a significantly increased risk of death at 30 days, 90 days, and 1 year compared to the first quartile of SHR (Q3 vs. Q1: HR 1.56-1.80, all p < 0.02; Q4 vs. Q1: HR 1.75-2.15, all p < 0.001; all p for trend < 0.001). In addition, the highest quartile of SHR was significantly associated with short-term or long-term mortality compared with the first quartile, regardless of diabetes status. CONCLUSIONS Our results suggest that stress hyperglycemia, defined by the glucose/HbA1c ratio, is associated with increased short-term and long-term mortality in patients with ischemic stroke, independent of the patient's diabetes status.
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Affiliation(s)
- Haowei Pan
- Second School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, China
| | - Yiqun Xiong
- Second School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, China
| | - Yanming Huang
- Second School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, China
- Department of Anesthesiology, Hangzhou Red Cross Hospital, 208 East Huancheng Road, Hangzhou, 310003, China
| | - Jie Zhao
- Department of Anesthesiology, Hangzhou Red Cross Hospital, 208 East Huancheng Road, Hangzhou, 310003, China
| | - Haifang Wan
- Department of Anesthesiology, Hangzhou Red Cross Hospital, 208 East Huancheng Road, Hangzhou, 310003, China.
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Psychogios K, Theodorou A, Kargiotis O, Safouris A, Velonakis G, Palaiodimou L, Spiliopoulos S, Giannopoulos S, Magoufis G, Tsivgoulis G. Hypoperfusion index ratio and pretreatment with intravenous thrombolysis are independent predictors of good functional outcome in acute ischemic stroke patients with large vessel occlusion treated with acute reperfusion therapies. Neurol Sci 2024:10.1007/s10072-024-07558-w. [PMID: 38761259 DOI: 10.1007/s10072-024-07558-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 04/22/2024] [Indexed: 05/20/2024]
Abstract
INTRODUCTION We aimed to investigate the performance of several neuroimaging markers provided by perfusion imaging of Acute Ischemic Stroke (AIS) patients with large vessel occlusion (LVO) in order to predict clinical outcomes following reperfusion treatments. METHODS We prospectively evaluated consecutive AIS patients with LVO who were treated with reperfusion therapies, during a six-year period. In order to compare patients with good (mRS scores 0-2) and poor (mRS scores 3-6) functional outcomes, data regarding clinical characteristics, the Alberta Stroke Programme Early Computed Tomography Score (ASPECTS) based on unenhanced computed tomography (CT), CT angiography collateral status and perfusion parameters including ischemic core, hypoperfusion volume, mismatch volume between core and penumbra, Tmax > 10 s volume, CBV index and the Hypoperfusion Index Ratio (HIR) were assessed. RESULTS A total of 84 acute stroke patients with LVO who met all the inclusion criteria were enrolled. In multivariable logistic regression models increasing age (odds ratio [OR]: 0.93; 95%CI: 0.88-0.96, p = 0.001), lower admission National Institute of Health Stroke Scale (NIHSS)-score (OR: 0.88; 95%CI: 0.80-0.95, p = 0.004), pretreatment with intravenous thrombolysis (OR: 3.83; 95%CI: 1.29-12.49, p = 0.019) and HIR (OR:0.36; 95%CI: 0.10-0.95, p = 0.042) were independent predictors of good functional outcome at 3 months. The initial univariable associations between HIR and higher likelihood for symptomatic intracranial hemorrhage (sICH) and parenchymal hematoma type 2 (PH2) were attenuated in multivariable analyses failing to reach statistical significance. DISCUSSION Our pilot observational study of unselected AIS patients with LVO treated with reperfusion therapies demonstrated that pre-treatment low HIR in perfusion imaging and IVT were associated with better functional outcomes.
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Affiliation(s)
- Klearchos Psychogios
- Stroke Unit, Metropolitan Hospital, 18547, Piraeus, Greece
- Second Department of Neurology, "Attikon" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Rimini 1, 12462, Chaidari, Athens, Greece
| | - Aikaterini Theodorou
- Second Department of Neurology, "Attikon" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Rimini 1, 12462, Chaidari, Athens, Greece
| | | | - Apostolos Safouris
- Stroke Unit, Metropolitan Hospital, 18547, Piraeus, Greece
- Second Department of Neurology, "Attikon" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Rimini 1, 12462, Chaidari, Athens, Greece
| | - Georgios Velonakis
- Second Department of Radiology, "Attikon" University Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462, Athens, Greece
| | - Lina Palaiodimou
- Second Department of Neurology, "Attikon" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Rimini 1, 12462, Chaidari, Athens, Greece
| | - Stavros Spiliopoulos
- Second Department of Radiology, Interventional Radiology Unit, "Attikon" University Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462, Athens, Greece
| | - Sotirios Giannopoulos
- Second Department of Neurology, "Attikon" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Rimini 1, 12462, Chaidari, Athens, Greece
| | - Georgios Magoufis
- Second Department of Radiology, Interventional Radiology Unit, "Attikon" University Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462, Athens, Greece
- Neuroradiology Department, Metropolitan Hospital, 18547, Piraeus, Greece
| | - Georgios Tsivgoulis
- Second Department of Neurology, "Attikon" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Rimini 1, 12462, Chaidari, Athens, Greece.
- Department of Neurology, University of Tennessee Health Science Center, Memphis, TN, 38163, USA.
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Gendosz de Carrillo D, Kocikowska O, Rak M, Krzan A, Student S, Jędrzejowska-Szypułka H, Pawletko K, Lasek-Bal A. The Relevance of Reperfusion Stroke Therapy for miR-9-3p and miR-9-5p Expression in Acute Stroke-A Preliminary Study. Int J Mol Sci 2024; 25:2766. [PMID: 38474013 DOI: 10.3390/ijms25052766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 02/21/2024] [Accepted: 02/22/2024] [Indexed: 03/14/2024] Open
Abstract
Reperfusion stroke therapy is a modern treatment that involves thrombolysis and the mechanical removal of thrombus from the extracranial and/or cerebral arteries, thereby increasing penumbra reperfusion. After reperfusion therapy, 46% of patients are able to live independently 3 months after stroke onset. MicroRNAs (miRNAs) are essential regulators in the development of cerebral ischemia/reperfusion injury and the efficacy of the applied treatment. The first aim of this study was to examine the change in serum miRNA levels via next-generation sequencing (NGS) 10 days after the onset of acute stroke and reperfusion treatment. Next, the predictive values of the bioinformatics analysis of miRNA gene targets for the assessment of brain ischemic response to reperfusion treatment were explored. Human serum samples were collected from patients on days 1 and 10 after stroke onset and reperfusion treatment. The samples were subjected to NGS and then validated using qRT-PCR. Differentially expressed miRNAs (DEmiRNAs) were used for enrichment analysis. Hsa-miR-9-3p and hsa-miR-9-5p expression were downregulated on day 10 compared to reperfusion treatment on day 1 after stroke. The functional analysis of miRNA target genes revealed a strong association between the identified miRNA and stroke-related biological processes related to neuroregeneration signaling pathways. Hsa-miR-9-3p and hsa-miR-9-5p are potential candidates for the further exploration of reperfusion treatment efficacy in stroke patients.
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Affiliation(s)
- Daria Gendosz de Carrillo
- Department of Physiology, Faculty of Medicine, Medical University of Silesia in Katowice, 40-752 Katowice, Poland
- Department of Histology and Cell Pathology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, 40-752 Katowice, Poland
| | - Olga Kocikowska
- Department of Physiology, Faculty of Medicine, Medical University of Silesia in Katowice, 40-752 Katowice, Poland
- Department of Engineering and Systems Biology, Faculty of Automatic Control, Electronics and Computer Science, Silesian University of Technology, 44-100 Gliwice, Poland
| | - Małgorzata Rak
- Department of Physiology, Faculty of Medicine, Medical University of Silesia in Katowice, 40-752 Katowice, Poland
| | - Aleksandra Krzan
- Department of Neurology, School of Health Sciences, Medical University of Silesia in Katowice, 40-752 Katowice, Poland
- Department of Neurology, Upper-Silesian Medical Center of the Silesian Medical University, 40-752 Katowice, Poland
| | - Sebastian Student
- Department of Engineering and Systems Biology, Faculty of Automatic Control, Electronics and Computer Science, Silesian University of Technology, 44-100 Gliwice, Poland
- Biotechnology Centre, Silesian University of Technology, 44-100 Gliwice, Poland
| | - Halina Jędrzejowska-Szypułka
- Department of Physiology, Faculty of Medicine, Medical University of Silesia in Katowice, 40-752 Katowice, Poland
| | - Katarzyna Pawletko
- Department of Physiology, Faculty of Medicine, Medical University of Silesia in Katowice, 40-752 Katowice, Poland
- Department for Experimental Medicine, Medical University of Silesia in Katowice, 40-752 Katowice, Poland
| | - Anetta Lasek-Bal
- Department of Neurology, School of Health Sciences, Medical University of Silesia in Katowice, 40-752 Katowice, Poland
- Department of Neurology, Upper-Silesian Medical Center of the Silesian Medical University, 40-752 Katowice, Poland
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Yang B, Chen X, Li F, Zhang J, Dong D, Ou H, Lu L, He N, Xu X, Xin X, Lu J, Guan M, Qiao H, Xu A, Zhu H. Stress hyperglycemia increases short-term mortality in acute ischemic stroke patients after mechanical thrombectomy. Diabetol Metab Syndr 2024; 16:32. [PMID: 38297321 PMCID: PMC10829332 DOI: 10.1186/s13098-024-01272-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 01/19/2024] [Indexed: 02/02/2024] Open
Abstract
BACKGROUND AND PURPOSE Glucose-to-glycated hemoglobin ratio (GAR) is considered a more reliable marker of stress hyperglycemia by correcting for basal blood glucose levels. This study aimed to investigate the extent to which GAR is associated with 3 month and 1 year all-cause mortalities in patients with acute ischemic stroke (AIS) undergoing mechanical thrombectomy (MT). METHODS We retrospectively followed 553 AIS patients who underwent MT. The degree of stress hyperglycemia was quantified as the GAR, defined as fasting plasma glucose (mmol/L)/hemoglobin A1c (HbA1c) (%) on the second day after admission. According to the GAR quartiles, the patients were further categorized into four groups (group 1-group 4). We assessed the association between GAR and all-cause mortalities, clinical outcomes during hospitalization and function outcomes at 3 months. The associations between stress hyperglycemia and all-cause mortalities were analyzed using a Cox proportional-hazards model, while other outcomes were analyzed using multiple logistic regression analysis. RESULTS The follow-up lasted a median of 18 months (range 0-66 months). The 3 month mortality rate was 9.58% (n = 53) and the 1 year mortality rate was 18.62% (n = 103). The Kaplan-Meier analysis revealed a significant inverse relationship between GAR and mortality (P < 0.001). In the Cox proportional-hazards model at 3 months, compared with group1, group 4 of GAR was associated with a significant increase in the risk of 3 month mortality (hazard ratio [HR] = 4.11, 95% confidence interval [CI] 1.41-12.0, P = 0.01) after adjusting for potential covariates. On multivariate logistic regression analysis, GAR was strongly associated with an increased risk of 3 month poor function outcome. CONCLUSIONS Stress hyperglycemia, quantified by a higher GAR, is associated with all-cause mortality and poor functional outcomes in patients with AIS who undergo MT. Furthermore, GAR may contribute to improving the predictive efficiency of all-cause mortality in patients with AIS after MT, especially short-term all-cause mortality.
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Affiliation(s)
- Bing Yang
- Department of Neurology and Stroke Center, The First Affiliated Hospital, Jinan University, 613 Huangpu Avenue west, Guangzhou, China
- Clinical Neuroscience Institute, Jinan University, Guangzhou, China
| | - Xuefang Chen
- Department of Neurology and Stroke Center, The First Affiliated Hospital, Jinan University, 613 Huangpu Avenue west, Guangzhou, China
- Department of Neurology, The Dongguan Affiliated Hospital of Jinan University, Binhaiwan Central Hospital of Dongguan, Dongguan, China
| | - Fangze Li
- Department of Neurology and Stroke Center, The First Affiliated Hospital, Jinan University, 613 Huangpu Avenue west, Guangzhou, China
- Clinical Neuroscience Institute, Jinan University, Guangzhou, China
| | - Junrun Zhang
- Department of Neurology and Stroke Center, The First Affiliated Hospital, Jinan University, 613 Huangpu Avenue west, Guangzhou, China
- Clinical Neuroscience Institute, Jinan University, Guangzhou, China
| | - Dawei Dong
- Department of Neurology and Stroke Center, The First Affiliated Hospital, Jinan University, 613 Huangpu Avenue west, Guangzhou, China
- Department of Neurology, the Affiliated Shunde Hospital of Jinan University, Foshan, China
| | - Huiyue Ou
- Department of Neurology and Stroke Center, The First Affiliated Hospital, Jinan University, 613 Huangpu Avenue west, Guangzhou, China
- Clinical Neuroscience Institute, Jinan University, Guangzhou, China
| | - Longyan Lu
- Department of Neurology and Stroke Center, The First Affiliated Hospital, Jinan University, 613 Huangpu Avenue west, Guangzhou, China
- Clinical Neuroscience Institute, Jinan University, Guangzhou, China
| | - Niu He
- Department of Neurology and Stroke Center, The First Affiliated Hospital, Jinan University, 613 Huangpu Avenue west, Guangzhou, China
- Clinical Neuroscience Institute, Jinan University, Guangzhou, China
| | - Xiaohong Xu
- Department of Neurology and Stroke Center, The First Affiliated Hospital, Jinan University, 613 Huangpu Avenue west, Guangzhou, China
- Clinical Neuroscience Institute, Jinan University, Guangzhou, China
| | - Xiufeng Xin
- Department of Neurology and Stroke Center, The First Affiliated Hospital, Jinan University, 613 Huangpu Avenue west, Guangzhou, China
- Clinical Neuroscience Institute, Jinan University, Guangzhou, China
| | - Jingchong Lu
- Department of Neurology and Stroke Center, The First Affiliated Hospital, Jinan University, 613 Huangpu Avenue west, Guangzhou, China
- Clinical Neuroscience Institute, Jinan University, Guangzhou, China
| | - Min Guan
- Department of Neurology and Stroke Center, The First Affiliated Hospital, Jinan University, 613 Huangpu Avenue west, Guangzhou, China
- Clinical Neuroscience Institute, Jinan University, Guangzhou, China
| | - Hongyu Qiao
- Department of Neurology and Stroke Center, The First Affiliated Hospital, Jinan University, 613 Huangpu Avenue west, Guangzhou, China
- Clinical Neuroscience Institute, Jinan University, Guangzhou, China
| | - Anding Xu
- Department of Neurology and Stroke Center, The First Affiliated Hospital, Jinan University, 613 Huangpu Avenue west, Guangzhou, China.
- Clinical Neuroscience Institute, Jinan University, Guangzhou, China.
| | - Huili Zhu
- Department of Neurology and Stroke Center, The First Affiliated Hospital, Jinan University, 613 Huangpu Avenue west, Guangzhou, China.
- Clinical Neuroscience Institute, Jinan University, Guangzhou, China.
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8
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Lasek-Bal A, Rybicki W, Student S, Puz P, Krzan A, Derra A. Direct Exposure to Outdoor Air Pollution Worsens the Functional Status of Stroke Patients Treated with Mechanical Thrombectomy. J Clin Med 2024; 13:746. [PMID: 38337439 PMCID: PMC10856015 DOI: 10.3390/jcm13030746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 01/14/2024] [Accepted: 01/24/2024] [Indexed: 02/12/2024] Open
Abstract
Background The effect of air pollutants on the functional status of stroke patients in short-term follow-up is unknown. The aim of this study was to evaluate the effect of air pollution occurring in the stroke period and during hospitalization on the functional status of patients undergoing mechanical thrombectomy (MT). Methods Our study included stroke patients for which the individual-level exposure to ambient levels of O3, CO, SO2, NO2, PM2.5, and PM10 during the acute stroke period was assessed. The correlations between the air pollutants' concentration and the patients' functional state were analyzed. A total of 499 stroke patients (mean age: 70) were qualified. Results The CO concentration at day of stroke onset was found to be significant regarding the functional state of patients on the 10th day (OR 0.014 95% CI 0-0.908, p = 0.048). The parameters which increased the risk of death in the first 10 days were as follows: NIHSS (OR 1.27; 95% CI 1.15-1.42; p < 0.001), intracranial bleeding (OR 4.08; 95% CI 1.75-9.76; p = 0.001), and SO2 concentration on day 2 (OR 1.21; 95% CI 1.02-1.47; p = 0.03). The parameters which increased the mortality rate within 90 days include age (OR 1.07; 95% CI 1.02-1.13; p = 0.005) and NIHSS (OR 1.37; 95% CI 1.19-1.63; p < 0.001). Conclusions Exposure to air pollution with CO and SO2 during the acute stroke phase has adverse effects on the patients' functional status. A combination of parameters, such as neurological state, hemorrhagic transformation, and SO2 exposure, is unfavorable in terms of the risk of death during a hospitalization due to stroke. The risk of a worsened functional status of patients in the first month of stroke rises along with the increase in particulate matter concentrations within the first days of stroke.
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Affiliation(s)
- Anetta Lasek-Bal
- Department of Neurology, School of Health Sciences, Medical University of Silesia in Katowice, 40-055 Katowice, Poland; (P.P.); (A.K.)
- Department of Neurology, Upper-Silesian Medical Centre of the Silesian Medical University in Katowice, 40-635 Katowice, Poland; (W.R.); (A.D.)
| | - Wiktor Rybicki
- Department of Neurology, Upper-Silesian Medical Centre of the Silesian Medical University in Katowice, 40-635 Katowice, Poland; (W.R.); (A.D.)
| | - Sebastian Student
- Faculty of Automatic Control Electronics and Computer Science, Silesian University of Technology, 44-100 Gliwice, Poland;
- Biotechnology Center, Silesian University of Technology, 44-100 Gliwice, Poland
| | - Przemysław Puz
- Department of Neurology, School of Health Sciences, Medical University of Silesia in Katowice, 40-055 Katowice, Poland; (P.P.); (A.K.)
- Department of Neurology, Upper-Silesian Medical Centre of the Silesian Medical University in Katowice, 40-635 Katowice, Poland; (W.R.); (A.D.)
| | - Aleksandra Krzan
- Department of Neurology, School of Health Sciences, Medical University of Silesia in Katowice, 40-055 Katowice, Poland; (P.P.); (A.K.)
- Department of Neurology, Upper-Silesian Medical Centre of the Silesian Medical University in Katowice, 40-635 Katowice, Poland; (W.R.); (A.D.)
| | - Aleksandra Derra
- Department of Neurology, Upper-Silesian Medical Centre of the Silesian Medical University in Katowice, 40-635 Katowice, Poland; (W.R.); (A.D.)
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9
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Li X, Li C, Liu AF, Jiang CC, Zhang YQ, Liu YE, Zhang YY, Li HY, Jiang WJ, Lv J. Application of a nomogram model for the prediction of 90-day poor outcomes following mechanical thrombectomy in patients with acute anterior circulation large-vessel occlusion. Front Neurol 2024; 15:1259973. [PMID: 38313559 PMCID: PMC10836145 DOI: 10.3389/fneur.2024.1259973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 01/02/2024] [Indexed: 02/06/2024] Open
Abstract
Background The past decade has witnessed advancements in mechanical thrombectomy (MT) for acute large-vessel occlusions (LVOs). However, only approximately half of the patients with LVO undergoing MT show the best/independent 90-day favorable outcome. This study aimed to develop a nomogram for predicting 90-day poor outcomes in patients with LVO treated with MT. Methods A total of 187 patients who received MT were retrospectively analyzed. Factors associated with 90-day poor outcomes (defined as mRS of 4-6) were determined by univariate and multivariate logistic regression analyzes. One best-fit nomogram was established to predict the risk of a 90-day poor outcome, and a concordance index was utilized to evaluate the performance of the model. Additionally, 145 patients from a single stroke center were retrospectively recruited as the validation cohort to test the newly established nomogram. Results The overall incidence of 90-day poor outcomes was 45.16%, affecting 84 of 186 patients in the training set. Moreover, five variables, namely, age (odds ratio [OR]: 1.049, 95% CI [1.016-1.083]; p = 0.003), glucose level (OR: 1.163, 95% CI [1.038-1.303]; p = 0.009), baseline National Institute of Health Stroke Scale (NIHSS) score (OR: 1.066, 95% CI [0.995-1.142]; p = 0.069), unsuccessful recanalization (defined as a TICI grade of 0 to 2a) (OR: 3.730, 95% CI [1.688-8.245]; p = 0.001), and early neurological deterioration (END, defined as an increase of ≥4 points between the baseline NIHSS score and the NIHSS score at 24 h after MT) (OR: 3.383, 95% CI [1.411-8.106]; p = 0.006), were included in the nomogram to predict the potential risk of poor outcomes at 90 days following MT in LVO patients, with a C-index of 0.763 (0.693-0.832) in the training set and 0.804 (0.719-0.889) in the validation set. Conclusion The proposed nomogram provided clinical evidence for the effective control of these risk factors before or during the process of MT surgery in LVO patients.
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Affiliation(s)
- Xia Li
- The PLA Rocket Force Characteristic Medical Center, Beijing, China
- Department of Neurology, Baotou Center Hospital, Neurointerventional Medical Center of Inner Mongolia Medical University, Institute of Cerebrovascular Disease in Inner Mongolia, Inner Mongolia, China
| | - Chen Li
- The PLA Rocket Force Characteristic Medical Center, Beijing, China
| | - Ao-Fei Liu
- The PLA Rocket Force Characteristic Medical Center, Beijing, China
| | - Chang-Chun Jiang
- Department of Neurology, Baotou Center Hospital, Neurointerventional Medical Center of Inner Mongolia Medical University, Institute of Cerebrovascular Disease in Inner Mongolia, Inner Mongolia, China
| | - Yi-Qun Zhang
- The PLA Rocket Force Characteristic Medical Center, Beijing, China
| | - Yun-E Liu
- The PLA Rocket Force Characteristic Medical Center, Beijing, China
| | - Ying-Ying Zhang
- The PLA Rocket Force Characteristic Medical Center, Beijing, China
| | - Hao-Yang Li
- Department of Psychiatric Specialty, Capital Medical University, Beijing, China
| | - Wei-Jian Jiang
- The PLA Rocket Force Characteristic Medical Center, Beijing, China
| | - Jin Lv
- The PLA Rocket Force Characteristic Medical Center, Beijing, China
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10
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Elhefnawy M, Nazifah Sidek N, Maisharah Sheikh Ghadzi S, Ibrahim B, Looi I, Abdul Aziz Z, Noor Harun S. Prevalence of Stroke-Associated Pneumonia and Its Predictors Among Hyperglycaemia Patients During Acute Ischemic Stroke. Cureus 2024; 16:e52574. [PMID: 38371076 PMCID: PMC10874618 DOI: 10.7759/cureus.52574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2024] [Indexed: 02/20/2024] Open
Abstract
BACKGROUND Hyperglycaemia (HG) during an acute ischemic stroke (AIS) is not only associated with unfavourable functional outcomes but also associated with stroke-associated pneumonia (SAP). This study aimed to determine the prevalence of SAP among Malaysian patients with AIS and the predictors of SAP among patients with HG during AIS. METHODS This is a retrospective cross-sectional study that included patients with AIS admitted to Hospital Sultanah Nur Zahirah, Malaysia from 2017 to 2020. SAP was defined as infection with pneumonia during the first seven days after IS. HG was defined as a blood glucose level > 7.8 mmol/L within 72 h after admission. Patients with SAP were divided into two groups according to HG status. Multivariate logistic regression analysis was performed using SPSS software, version 22 (IBM Corp., Armonk, NY) to identify SAP predictors among patients with HG. Kaplan-Meier log-rank test was used to compare the survival rate from unfavourable functional outcomes between hyperglycaemic patients with and without SAP. RESULTS Among 412 patients with AIS, 69 (16.74%) had SAP. The prevalence of SAP among patients with HG and normoglycemia during AIS was 20.98%, and 10.65%, respectively. Age above 60 years, leucocytosis, and National Institute of Health Stroke Scale (NIHSS) > 14 on admission were independent predictors of SAP with aOR of 2.08 (95% CI;1.01-4.30), 2.83 (95% CI; 1.41-5.67), and 3.67 (95% CI; 1.53-8.80), respectively. No significant difference in unfavourable functional outcomes survival was found among patients with and without SAP (p = 0.653). CONCLUSION This study demonstrated the prevalence of SAP was higher among patients with HG compared to normoglycemia during AIS. The patient being old, leucocytosis and severe stroke upon admission predict the occurrence of SAP among patients with HG during AIS.
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Affiliation(s)
- Marwa Elhefnawy
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, MYS
| | | | | | | | - Irene Looi
- Clinical Research Centre, Hospital Seberang Jaya, Seberang Jaya, MYS
| | - Zariah Abdul Aziz
- Clinical Research Centre, Hospital Sultanah Nur Zahirah, Terengganu, MYS
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11
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Li R, Nguyen TN, Xu P, Tao C, Chen W, Cao Z, Yin Y, Wang L, Chen J, Wang Z, Sun J, Chen L, Hao P, Feng S, Liu X, Hu W. Effects of admission hyperglycemia and intravenous thrombolysis allocation in acute basilar artery occlusion after endovascular treatment: Analysis of the ATTENTION registry. Neurotherapeutics 2024; 21:e00303. [PMID: 38241159 PMCID: PMC10903088 DOI: 10.1016/j.neurot.2023.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Accepted: 10/17/2023] [Indexed: 01/21/2024] Open
Abstract
This study was to investigate the admission hyperglycemia and modified effect of intravenous thrombolysis (IVT) on clinical outcomes in acute basilar artery occlusion (BAO) patients receiving endovascular treatment (EVT). We prospectively recruited acute BAO patients from 48 stroke centers across 22 Chinese provinces in the ATTENTION registry from 2017 to 2021. Hyperglycemia on admission was defined as glucose ≥7.8 mmol/L. We performed multivariable logistic regression analysis to evaluate the correlation of hyperglycemia on admission with the primary outcome defined as a modified Rankin scale (mRS) score of <4 at 90 days, and the secondary outcomes defined as successful recanalization, mRS 0-1 and 0-2 at 90 days. Safety outcomes were symptomatic intracranial hemorrhage (sICH) and mortality within 90 days. There were 1195 patients with acute BAO treated with EVT of whom 519 had hyperglycemia on admission. Hyperglycemia on admission was inversely associated with favorable neurological outcomes (mRS 0-3: adjusted odd ratio [aOR] 0.69, 95 % confidence intervals [CI] 0.54-0.89, P = 0.004; mRS 0-1: aOR 0.67, 95 % CI 0.50-0.90, P = 0.008; mRS 0-2: aOR 0.73, 95 % CI 0.56-0.95; P = 0.02). Hyperglycemia on admission was not correlated to sICH nor successful recanalization. In the subgroup of BAO patients treated with direct EVT, those with hyperglycemia on admission had a higher mortality rate, and overall worse clinical outcomes at 90 days than patients without hyperglycemia. A significant interaction was observed between IVT and hyperglycemia on admission (Pinteraction = 0.017). In patients with acute BAO treated with EVT, hyperglycemia on admission was associated with worse functional outcomes at 90 days but was not correlated with sICH nor successful recanalization. The effect of admission hyperglycemia appears to be modified by IVT allocation. Unique identifier: ChiCTR2000041117.
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Affiliation(s)
- Rui Li
- Department of Neurology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Thanh N Nguyen
- Department of Neurology, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Pengfei Xu
- Department of Neurology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Chunrong Tao
- Department of Neurology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Wenhuo Chen
- Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, China
| | - Zhihua Cao
- Department of Neurology, Xiangyang No.1 People's Hospital, Hubei University of Medicine, Xiangyang, China
| | - Yamei Yin
- Department of Neurology, Provincial Hospital Affiliated to Anhui Medical University, Hefei, China
| | - Li Wang
- Department of Neurology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Juan Chen
- Department of Neurology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Zi Wang
- Department of Neurology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Jun Sun
- Department of Neurology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Lang Chen
- Department of Neurology, Provincial Hospital Affiliated to Anhui Medical University, Hefei, China
| | - Peng Hao
- Department of Neurology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Shuo Feng
- Department of Neurology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Xinfeng Liu
- Department of Neurology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China.
| | - Wei Hu
- Department of Neurology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China.
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12
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Li J, Duan J, Zhang L, Chen J, Duan Y, Yang B. Low (0-5) Alberta Stroke Program Early Computed Tomography Score on admission predictive of worse functional outcome after mechanical thrombectomy for anterior circulation large vessel occlusion. Eur J Med Res 2023; 28:266. [PMID: 37542346 PMCID: PMC10401741 DOI: 10.1186/s40001-023-01225-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 07/12/2023] [Indexed: 08/06/2023] Open
Abstract
BACKGROUND AND PURPOSE We examined functional outcomes of mechanical thrombectomy (MT) procedures following anterior circulation large vessel occlusion (ACLVO)-related acute ischemic strokes (AIS). Results were based on admission non-contrast computed tomography (NCCT) studies, using the Alberta Stroke Program Early Computed Tomography Score (ASPECTS) as standard metric. METHODS Qualifying subjects were consecutive patients (N = 343) at a single center undergoing MT for ACLVO-related AIS. Each was grouped according to ASPECTS status on admission, determined from NCCT images by two physicians. Primary clinical endpoint was functional independence, assessed via modified Rankin Scale (mRS) at 90 days. Secondary endpoints were vessel recanalization (i.e., modified Thrombolysis in Cerebral Infarction [mTICI] score), symptomatic intracranial hemorrhage (sICH), and mortality. RESULTS In this study population (mean age, 63.6 ± 12.6 years; women, 30.3%; median baseline National Institute of Health Stroke Scale [NIHSS] score, 15.2 ± 4.5), patients were stratified by ASPECTS tier at presentation, either 0-5 (n = 50) or 6-10 (n = 293). Multivariate logistic regression showed a relation between ASPECTS values ≤ 5 and lesser chance of 90-day functional improvement (OR = 2.309, 95% confidence interval [CI] 1.012-5.271; p = 0.047), once adjusted for age, baseline NIHSS score, diabetes mellitus, HbA1c concentration, D-dimer level, occlusive location, numbers of device passes, and successful recanalization. CONCLUSIONS ASPECTS values ≤ 5 correspond with worse long-term functional improvement (mRS scores > 2) in patients undergoing MT for ACLVO-related AIS. Other independent determinants of functional outcomes after MT are age, baseline NIHSS score, HbA1c concentration, and successful recanalization.
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Affiliation(s)
- Jinze Li
- Jinzhou Medical University General Hospital of Northern Theater Command Postgraduate Training Base, Shenyang, China
- Center for Neuroimaging, Department of Radiology, General Hospital of Northern Theater Command, Shenyang, China
| | - Jinfeng Duan
- Department of Surgery, General Hospital of Northern Theater Command, Shenyang, China
| | - Luojin Zhang
- Center for Neuroimaging, Department of Radiology, General Hospital of Northern Theater Command, Shenyang, China
- Dalian Medical University General Hospital of Northern Theater Command Postgraduate Training Base, Shenyang, China
| | - Jingshu Chen
- Department of Radiology, General Hospital of Northern Theater Command, 83 Wenhua Road, Shenhe District, Shenyang, 110016, Liaoning, China
| | - Yang Duan
- Center for Neuroimaging, Department of Radiology, General Hospital of Northern Theater Command, Shenyang, China
| | - Benqiang Yang
- Department of Radiology, General Hospital of Northern Theater Command, 83 Wenhua Road, Shenhe District, Shenyang, 110016, Liaoning, China.
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13
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Zhang L, Gao F, Tian Y, Li L, Tian Y, Guo C, Yang D, Yue C, Song J, Zi W, Li J, Liu Z. Association Between Admission Hyperglycemia and Outcomes After Endovascular Treatment in Acute Basilar Artery Occlusion. Neurol Ther 2023; 12:1285-1297. [PMID: 37266794 PMCID: PMC10310590 DOI: 10.1007/s40120-023-00502-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 05/16/2023] [Indexed: 06/03/2023] Open
Abstract
INTRODUCTION Admission hyperglycemia and high admission blood glucose levels have been associated with poor outcomes in acute ischemic stroke. However, the relationship between admission hyperglycemia and outcomes after endovascular treatment (EVT) in acute basilar artery occlusion (ABAO) still remain unclear. This study aimed to investigate the association between admission hyperglycemia and clinical outcomes in ABAO following EVT. METHODS Patients from the BASILAR registry with admission blood glucose levels treated with EVT were included. We defined admission hyperglycemia as blood glucose levels ≥ 7.8 mmol/L. The primary outcome was favorable outcome [defined as a modified Rankin Scale score (mRS) of 0-3] at 90 days, Secondary outcomes included other functional outcomes (mRS 0-2, mRS 0-1) at 90 days, symptomatic intracerebral hemorrhage (sICH) within 48 h, and mortality at 90 days. RESULTS Of 545 eligible patients included, the median age was 65 (IQR, 56-73) years, and median blood glucose level was 7.36 (IQR, 6.10-9.66) mmol/L. Multivariable logistic regression analysis showed that admission hyperglycemia was associated with decreased favorable outcome (mRS 0-3) (adjusted odds ratio = 0.52; 95% CI 0.35-0.79; P = 0.001), and increased mortality (adjusted odds ratio = 2.67; 95% CI 1.82-3.91; P < 0.001). Restricted cubic spline regression analysis showed that the blood glucose level had a non-linearity association with favorable outcome and mortality, and that there was no association between admission hyperglycemia and sICH. CONCLUSIONS Our study suggest that admission hyperglycemia is associated with an increased risk of poor functional outcomes and mortality in patients with ABAO treated with EVT. TRIAL REGISTRATION Chinese Clinical Trial Registry ( http://www.chictr.org.cn ), ChiCTR180001475.
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Affiliation(s)
- Lijiao Zhang
- Department of Emergency, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Fei Gao
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Yaoyu Tian
- Department of Neurology, Qian Xi Nan People's Hospital, Guizhou, China
| | - Linyu Li
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Yan Tian
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Changwei Guo
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Dahong Yang
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Chengsong Yue
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Jiaxing Song
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Wenjie Zi
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Jia Li
- Department of Emergency, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Zhenqian Liu
- Department of Neurology, The Second Affiliated Hospital of Xuzhou Medical University, 32 Coalroad, Xuzhou, 221006, Jiangsu, China.
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14
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Bains NK, Huang W, French BR, Siddiq F, Gomez CR, Qureshi AI. Hyperglycemic control in acute ischemic stroke patients undergoing endovascular treatment: post hoc analysis of the Stroke Hyperglycemia Insulin Network Effort trial. J Neurointerv Surg 2023; 15:370-374. [PMID: 35414602 DOI: 10.1136/neurintsurg-2021-018485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 03/19/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Hyperglycemia has been associated with poor outcomes in acute ischemic stroke patients undergoing endovascular treatment. We analyzed the effect of intensive glucose control on death and disability rates in patients with acute ischemic stroke undergoing endovascular treatment. METHODS We analyzed the effect of intensive (serum glucose <110 mg/dL) glucose treatment (compared with standard treatment, serum glucose <180 mg/dL) in patients who received endovascular treatment in the Stroke Hyperglycemia Insulin Network Effort (SHINE) trial. We further analyzed the effect of area under the curve (AUC) of serum glucose, proportion of the time blood glucose was <140 mg/dL, and glucose variability defined as the glucose range during 72 hours. The primary outcomes were neurological deterioration within 72 hours and outcome at 90 days. RESULTS A total of 146 patients (mean age 68.1±13.9 years, 50.7% men) underwent endovascular treatment for acute ischemic stroke; 72 and 74 patients were randomized to intensive and standard treatments, respectively. The rates of death (20.3% and 22.2%), favorable 90-day primary outcome (17.6% and 19.4%), and serious adverse events (41.9% and 56.98%) were similar between the two groups. The AUC of serum glucose was not associated with death within 90 days (OR 1, 95% CI 1 to 1) or favorable outcome at 90 days (OR 1, 95% CI 1 to 1). Glucose variability was not associated with death or favorable outcome at 90 days. CONCLUSION We did not identify any beneficial effect of intensive glucose reduction on rates of death or favorable outcomes at 90 days among acute ischemic stroke patients undergoing endovascular treatment.
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Affiliation(s)
- Navpreet K Bains
- Neurology, University of Missouri, Columbia, Missouri, USA .,Neurology, Zeenat Qureshi Stroke Institute, St. Cloud, Minnesota, USA
| | - Wei Huang
- Neurology, University of Missouri, Columbia, Missouri, USA.,Neurology, Zeenat Qureshi Stroke Institute, St. Cloud, Minnesota, USA
| | - Brandi R French
- Neurology, University of Missouri, Columbia, Missouri, USA.,Neurology, Zeenat Qureshi Stroke Institute, St. Cloud, Minnesota, USA
| | - Farhan Siddiq
- Neurology, Zeenat Qureshi Stroke Institute, St. Cloud, Minnesota, USA.,Neurosurgery, University of Missouri, Columbia, Missouri, USA
| | - Camilo R Gomez
- Neurology, University of Missouri, Columbia, Missouri, USA.,Neurology, Zeenat Qureshi Stroke Institute, St. Cloud, Minnesota, USA
| | - Adnan I Qureshi
- Neurology, University of Missouri, Columbia, Missouri, USA.,Neurology, Zeenat Qureshi Stroke Institute, St. Cloud, Minnesota, USA
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15
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Sun Y, Guo Y, Ji Y, Wu K, Wang H, Yuan L, Yang K, Yang Q, Huang X, Zhou Z. New stress-induced hyperglycaemia markers predict prognosis in patients after mechanical thrombectomy. BMC Neurol 2023; 23:132. [PMID: 36997874 PMCID: PMC10061963 DOI: 10.1186/s12883-023-03175-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 03/21/2023] [Indexed: 04/01/2023] Open
Abstract
OBJECTIVE Stress-induced hyperglycaemia (SIH) is a frequent phenomenon that occurs in patients with acute ischaemic stroke. The aim of this study was to investigate the relationship between SIH and the prognosis of mechanical thrombectomy (MT) patients according to the stress hyperglycemia ratio (SHR) and glycaemic gap (GG) indicators, as well as explore its relationship with haemorrhagic transformation (HT). METHODS Patients were enrolled from January 2019 to September 2021 in our centre. SHR was calculated as fasting blood glucose divided by the A1c-derived average glucose (ADAG). GG was calculated as fasting blood glucose minus ADAG. Logistic regression was used to analyse SHR, GG with outcome and HT. RESULTS A total of 423 patients were enrolled in the study. The incidence of SIH was as follows: 191/423 of patients with SHR > 0.89, 169/423 of patients with GG > -0.53. SHR > 0.89 (OR: 2.247, 95% CI: 1.344-3.756, P = 0.002) and GG>-0.53 (OR: 2.305, 95% CI: 1.370-3.879, P = 0.002) were both associated with poor outcomes (modified Rankin Scale > 2) at Day 90 and an increase risk of HT. Additionlly, receiver operating characteristic curves were used to assess the predictive performance of the SHR and GG on outcomes. The area under the curve for SHR to predict poor outcomes was 0.691, with an optimal cut-off value of 0.89. The area under the curve for GG was 0.682, with an optimal cut-off value of -0.53. CONCLUSION High SHR and high GG are strongly associated with poor 90-day prognosis in MT patients and an increased risk of HT.
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Affiliation(s)
- Yi Sun
- Department of Neurology, The First Affiliated Hospital of Wannan Medical College, 2# East Zheshan Road, Wuhu, 241000, People's Republic of China
| | - Yapeng Guo
- Department of Neurology, The First Affiliated Hospital of Wannan Medical College, 2# East Zheshan Road, Wuhu, 241000, People's Republic of China
| | - Yachen Ji
- Department of Neurology, The First Affiliated Hospital of Wannan Medical College, 2# East Zheshan Road, Wuhu, 241000, People's Republic of China
| | - Kangfei Wu
- Department of Neurology, The First Affiliated Hospital of Wannan Medical College, 2# East Zheshan Road, Wuhu, 241000, People's Republic of China
| | - Hao Wang
- Department of Neurology, The First Affiliated Hospital of Wannan Medical College, 2# East Zheshan Road, Wuhu, 241000, People's Republic of China
| | - Lili Yuan
- Department of Neurology, The First Affiliated Hospital of Wannan Medical College, 2# East Zheshan Road, Wuhu, 241000, People's Republic of China
| | - Ke Yang
- Department of Neurology, The First Affiliated Hospital of Wannan Medical College, 2# East Zheshan Road, Wuhu, 241000, People's Republic of China
| | - Qian Yang
- Department of Neurology, The First Affiliated Hospital of Wannan Medical College, 2# East Zheshan Road, Wuhu, 241000, People's Republic of China
| | - Xianjun Huang
- Department of Neurology, The First Affiliated Hospital of Wannan Medical College, 2# East Zheshan Road, Wuhu, 241000, People's Republic of China.
| | - Zhiming Zhou
- Department of Neurology, The First Affiliated Hospital of Wannan Medical College, 2# East Zheshan Road, Wuhu, 241000, People's Republic of China.
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16
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Anaesthetic and peri-operative management for thrombectomy procedures in stroke patients. Anaesth Crit Care Pain Med 2023; 42:101188. [PMID: 36599377 DOI: 10.1016/j.accpm.2022.101188] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 12/15/2022] [Indexed: 01/02/2023]
Abstract
PURPOSE To provide recommendations for the anaesthetic and peri-operative management for thrombectomy procedure in stroke patients DESIGN: A consensus committee of 15 experts issued from the French Society of Anaesthesia and Intensive Care Medicine (Société Française d'Anesthésie et Réanimation, SFAR), the Association of French-language Neuro-Anaesthetists (Association des Neuro-Anesthésistes Réanimateurs de Langue Francaise, ANARLF), the French Neuro-Vascular Society (Société Francaise de Neuro-Vasculaire, SFNV), the French Neuro-Radiology Society (Société Francaise de Neuro-Radiologie, SFNR) and the French Study Group on Haemostasis and Thrombosis (Groupe Français d'Études sur l'Hémostase et la Thrombose, GFHT) was convened, under the supervision of two expert coordinators from the SFAR and the ANARLF. A formal conflict-of-interest policy was developed at the outset of the process and enforced throughout. The entire guideline elaboration process was conducted independently of any industry funding. The authors were required to follow the principles of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system to guide their assessment of quality of evidence. METHODS Four fields were defined prior to the literature search: (1) Peri-procedural management, (2) Prevention and management of secondary brain injuries, (3) Management of antiplatelet and anticoagulant treatments, (4) Post-procedural management and orientation of the patient. Questions were formulated using the PICO format (Population, Intervention, Comparison, and Outcomes) and updated as needed. Analysis of the literature was then conducted and the recommendations were formulated according to the GRADE methodology. RESULTS The SFAR/ANARLF/SFNV/SFNR/GFHT guideline panel drew up 18 recommendations regarding anaesthetic management of mechanical thrombectomy procedures. Due to a lack of data in the literature allowing to conclude with high certainty on relevant clinical outcomes, the experts decided to formulate these guidelines as "Professional Practice Recommendations" (PPR) rather than "Formalized Expert Recommendations". After two rounds of rating and several amendments, a strong agreement was reached on 100% of the recommendations. No recommendation could be formulated for two questions. CONCLUSIONS Strong agreement among experts was reached to provide a sizable number of recommendations aimed at optimising anaesthetic management for thrombectomy in patients suffering from stroke.
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17
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Nasoohi S, Alehossein P, Jorjani M, Brown CM, Ishrat T. Intra-arterial verapamil improves functional outcomes of thrombectomy in a preclinical model of extended hyperglycemic stroke. Front Pharmacol 2023; 14:1161999. [PMID: 37124219 PMCID: PMC10134451 DOI: 10.3389/fphar.2023.1161999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 03/30/2023] [Indexed: 05/02/2023] Open
Abstract
The abrupt hyperglycemic reperfusion following thrombectomy has been shown to harm the efficacy of the intervention in stroke patients with large vessel occlusion. Studies of ours and others have shown thioredoxin-interacting protein (TXNIP) is critically involved in hyperglycemic stroke injury. We recently found verapamil ameliorates cerebrovascular toxicity of tissue plasminogen activators in hyperglycemic stroke. The present study aims to answer if verapamil exerts direct neuroprotective effects and alleviates glucose toxicity following thrombectomy in a preclinical model of hyperglycemic stroke. Primary cortical neural (PCN) cultures were exposed to hyperglycemic reperfusion following oxygen-glucose deprivation (OGD), with or without verapamil treatment. In a mouse model of intraluminal stroke, animals were subjected to 4 h middle cerebral artery occlusion (MCAO) and intravenous glucose infusion. Glucose infusion lasted one more hour at reperfusion, along with intra-arterial (i.a.) verapamil infusion. Animals were subjected to sensorimotor function tests and histological analysis of microglial phenotype at 72 h post-stroke. According to our findings, glucose concentrations (2.5-20 mM) directly correlated with TXNIP expression in OGD-exposed PCN cultures. Verapamil (100 nM) effectively improved PCN cell neurite growth and reduced TXNIP expression as well as interaction with NOD-like receptor pyrin domain-containing-3 (NLRP3) inflammasome, as determined by immunoblotting and immunoprecipitation. In our mouse model of extended hyperglycemic MCAO, i.a. verapamil (0.5 mg/kg) could attenuate neurological deficits induced by hyperglycemic stroke. This was associated with reduced microglial pro-inflammatory transition. This finding encourages pertinent studies in hyperglycemic patients undergoing thrombectomy where the robust reperfusion may exacerbate glucose toxicity.
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Affiliation(s)
- Sanaz Nasoohi
- Neuroscience Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Neuroscience, School of Medicine, and Rockefeller Neuroscience Institute, West Virginia University, Morgantown, WV, United States
- *Correspondence: Sanaz Nasoohi,
| | - Parsa Alehossein
- Neuroscience Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Masoumeh Jorjani
- Department of Pharmacology, School of Medicine, Neurobiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Candice M. Brown
- Department of Neuroscience, School of Medicine, and Rockefeller Neuroscience Institute, West Virginia University, Morgantown, WV, United States
| | - Tauheed Ishrat
- Department of Anatomy and Neurobiology, School of Medicine, University of Tennessee Health Science Center, Memphis, TN, United States
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18
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Yao M, Hao Y, Wang T, Xie M, Li H, Feng J, Feng L, Ma D. A review of stress-induced hyperglycaemia in the context of acute ischaemic stroke: Definition, underlying mechanisms, and the status of insulin therapy. Front Neurol 2023; 14:1149671. [PMID: 37025208 PMCID: PMC10070880 DOI: 10.3389/fneur.2023.1149671] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Accepted: 02/21/2023] [Indexed: 04/08/2023] Open
Abstract
The transient elevation of blood glucose produced following acute ischaemic stroke (AIS) has been described as stress-induced hyperglycaemia (SIH). SIH is common even in patients with AIS who have no previous diagnosis of diabetes mellitus. Elevated blood glucose levels during admission and hospitalization are strongly associated with enlarged infarct size and adverse prognosis in AIS patients. However, insulin-intensive glucose control therapy defined by admission blood glucose for SIH has not achieved the desired results, and new treatment ideas are urgently required. First, we explore the various definitions of SIH in the context of AIS and their predictive value in adverse outcomes. Then, we briefly discuss the mechanisms by which SIH arises, describing the dual effects of elevated glucose levels on the central nervous system. Finally, although preclinical studies support lowering blood glucose levels using insulin, the clinical outcomes of intensive glucose control are not promising. We discuss the reasons for this phenomenon.
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Affiliation(s)
- Mengyue Yao
- Department of Neurology and Neuroscience Centre, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Yulei Hao
- Department of Neurology and Neuroscience Centre, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Tian Wang
- Department of Neurology and Neuroscience Centre, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Meizhen Xie
- Department of Neurology and Neuroscience Centre, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Hui Li
- Department of Neurology and Neuroscience Centre, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Jiachun Feng
- Department of Neurology and Neuroscience Centre, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Liangshu Feng
- Stroke Centre, Department of Neurology, The First Hospital of Jilin University, Changchun, Jilin, China
- Liangshu Feng
| | - Di Ma
- Department of Neurology and Neuroscience Centre, The First Hospital of Jilin University, Changchun, Jilin, China
- *Correspondence: Di Ma
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19
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Lei C, Li Y, Zhou X, Lin S, Zhu X, Yang X, Chen C. A Simple Grading Scale for Predicting Symptomatic Intracranial Hemorrhage after Mechanical Thrombectomy. Cerebrovasc Dis 2022; 52:401-408. [PMID: 36442461 PMCID: PMC10568605 DOI: 10.1159/000527254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 07/30/2022] [Indexed: 09/05/2023] Open
Abstract
INTRODUCTION Hemorrhagic transformation, especially symptomatic intracranial hemorrhage (sICH), is a common complication after mechanical embolectomy. This study explored a grading scale based on clinical and radiological parameters to predict sICH after mechanical embolectomy. METHODS Demographic and clinical data were retrospectively collected from patients with acute ischemic stroke treated with mechanical embolectomy at West China Hospital. Clinical and radiological factors associated with sICH were identified and used to develop the "STBA" grading scale. This score was then validated using data from an independent sample at the First Affiliated Hospital of Kunming Medical University. RESULTS We analyzed 268 patients with acute ischemic stroke who were treated with mechanical embolectomy at West China Hospital, of whom 30 (11.2%) had sICH. Patients were rated on an "STBA" score ranging from 0 to 6 based on whether systolic blood pressure was ≥145 mm Hg at admission (yes = 2 points; no = 0 points), time from acute ischemic stroke until groin puncture was ≥300 min (yes = 1; no = 0), blood glucose was ≥8.8 mmol/L (yes = 1; no = 0), and the Alberta Stroke Program Early Computed Tomography score at admission was 0-5 (2 points), 6-7 (1 point), or 8-10 (0 points). The STBA score showed good discrimination in the derivation sample (area under the receiver operating characteristic curve = 0.858) and in the validation sample (area = 0.814). CONCLUSIONS The STBA score may be a reliable clinical scoring system to predict sICH in acute ischemic stroke patients treated with mechanical embolectomy.
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Affiliation(s)
- Chunyan Lei
- From the Department of Neurology, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Yongyu Li
- From the Department of Neurology, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Xianlian Zhou
- From the Department of Neurology, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Shihan Lin
- From the Department of Neurology, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Xiaoyan Zhu
- From the Department of Neurology, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Xinglong Yang
- From the Department of Neurology, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Chun Chen
- From the Department of Neurology, First Affiliated Hospital of Kunming Medical University, Kunming, China
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20
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Santana D, Mosteiro A, Pedrosa L, Llull L, Torné R, Amaro S. Clinical relevance of glucose metrics during the early brain injury period after aneurysmal subarachnoid hemorrhage: An opportunity for continuous glucose monitoring. Front Neurol 2022; 13:977307. [PMID: 36172028 PMCID: PMC9512056 DOI: 10.3389/fneur.2022.977307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 08/25/2022] [Indexed: 11/13/2022] Open
Abstract
Hyperglycaemia, hypoglycaemia and higher glucose variability during the Early Brain Injury (EBI) period of aneurysmal subarachnoid hemorrhage (aSAH) have been associated with poor clinical outcome. However, it is unclear whether these associations are due to direct glucose-driven injury or if hyperglycaemia simply acts as a marker of initial severity. Actually, strict glucose control with intensive insulin therapy has not been demonstrated as an effective strategy for improving clinical outcomes after aSAH. Currently published studies describing an association between hyperglycaemia and prognosis in aSAH patients have been based on isolated glucose measurements and did not incorporate comprehensive dynamic evaluations, such as those derived from subcutaneous continuous glucose monitoring devices (CMG). Arguably, a more accurate knowledge on glycaemic patterns during the acute phase of aSAH could increase our understanding of the relevance of glycaemia as a prognostic factor in this disease as well as to underpin its contribution to secondary focal and diffuse brain injury. Herein, we have summarized the available evidence on the diagnostic and prognostic relevance of glucose metrics during the acute phase of cerebrovascular diseases, focusing in the EBI period after aSAH. Overall, obtaining a more precise scope of acute longitudinal glucose profiles could eventually be useful for improving glucose management protocols in the setting of acute aSAH and to advance toward a more personalized management of aSAH patients during the EBI phase.
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Affiliation(s)
- Daniel Santana
- Comprehensive Stroke Center, Institute of Neuroscience, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Alejandra Mosteiro
- Neurosurgery Department, Institute of Neuroscience, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Leire Pedrosa
- Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Laura Llull
- Comprehensive Stroke Center, Institute of Neuroscience, Hospital Clinic of Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Ramón Torné
- Neurosurgery Department, Institute of Neuroscience, Hospital Clinic of Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Department of Medicine, Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
- *Correspondence: Ramón Torné
| | - Sergi Amaro
- Comprehensive Stroke Center, Institute of Neuroscience, Hospital Clinic of Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Department of Medicine, Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
- Sergi Amaro
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21
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Genceviciute K, Göldlin MB, Kurmann CC, Mujanovic A, Meinel TR, Kaesmacher J, Seiffge DJ, Jung S, Mordasini P, Fischer U, Gralla J, Sarikaya H, Goeggel-Simonetti B, Antonenko K, Umarova RM, Bally L, Arnold M, Heldner MR. Association of diabetes mellitus and admission glucose levels with outcome after endovascular therapy in acute ischaemic stroke in anterior circulation. Eur J Neurol 2022; 29:2996-3008. [PMID: 35719010 PMCID: PMC9544025 DOI: 10.1111/ene.15456] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 06/13/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND We aimed to assess the association of diabetes mellitus (DM) and admission hyperglycaemia (AH) respectively and outcome in patients with acute ischaemic stroke with large vessel occlusion in the anterior circulation treated with endovascular therapy (EVT) in daily clinical practice. METHODS Consecutive EVT patients admitted to our stroke centre between 02/2015-04/2020 were included in this observational cohort study. Patients with vs. without DM and with vs. without AH≥7.8mmol/l were compared. RESULTS We included 1020 patients (48.9% women, median age 73.1 years). 282 (27.6%) and 226 (22.2%) had DM and/or AH. Patients with vs. without DM showed less often successful reperfusion (adjusted OR=0.61;p=0.023) and worse 3-month functional outcome (mRS:0-2:31.3% vs. 48%;adjusted OR=0.59;p=0.004, death:38.9% vs. 24.1%;adjusted OR=1.75;p=0.002 and mRS-shift:adjusted p<0.0001, if moderate/good collaterals and mismatch:mRS:0-2:adjusted OR=0.52;p=0.005, death:adjusted OR=1.95;p=0.005). If analysis was adjusted for AH additionally, only mRS-shift was still significantly worse in patients with DM (adjusted p=0.012). Patients with vs. without AH showed similar successful reperfusion rates and worse 3-month functional outcome (mRS:0-2:28.3% vs. 50.4%;adjusted OR=0.52;p<0.0001, death:40.4% vs. 22.4%;adjusted OR=1.80;p=0.001 and mRS-shift:adjusted p<0.0001, if moderate/good collaterals and mismatch:mRS:0-2:adjusted OR=0.38;p<0.0001, death:adjusted OR=2.39;p<0.0001). If analysis was adjusted for DM additionally, 3-month functional outcome remained significantly worse in patients with AH (mRS:0-2:adjusted OR=0.58;p=0.004, death:adjusted OR=1.57;p=0.014 and mRS-shift:adjusted p=0.004). DM independently predicted recurrent/progressive in-hospital ischaemic stroke (OR=1.71;p=0.043) together with admission NIHSS score (OR=0.95;p=0.005) and AH independently predicted in-hospital symptomatic intracranial haemorrhage (OR=2.21;p=0.001). The association of admission continuous glucose levels and most outcome variables was (inversely) J-shaped. CONCLUSIONS AH more than DM was associated with worse 3-month outcome in the patients studied - more likely so in case of moderate/good collaterals and mismatch in admission imaging.
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Affiliation(s)
- Kotryna Genceviciute
- Department of Neurology, Inselspital, University Hospital and University of Bern, Bern, Switzerland
| | - Martina B Göldlin
- Department of Neurology, Inselspital, University Hospital and University of Bern, Bern, Switzerland.,Institute of Diagnostic and Interventional Neuroradiology, Inselspital, University Hospital and University of Bern, Bern, Switzerland
| | - Christoph C Kurmann
- Institute of Diagnostic and Interventional Neuroradiology, Inselspital, University Hospital and University of Bern, Bern, Switzerland
| | - Adnan Mujanovic
- Institute of Diagnostic and Interventional Neuroradiology, Inselspital, University Hospital and University of Bern, Bern, Switzerland
| | - Thomas R Meinel
- Department of Neurology, Inselspital, University Hospital and University of Bern, Bern, Switzerland
| | - Johannes Kaesmacher
- Institute of Diagnostic and Interventional Neuroradiology, Inselspital, University Hospital and University of Bern, Bern, Switzerland
| | - David J Seiffge
- Department of Neurology, Inselspital, University Hospital and University of Bern, Bern, Switzerland
| | - Simon Jung
- Department of Neurology, Inselspital, University Hospital and University of Bern, Bern, Switzerland
| | - Pasquale Mordasini
- Institute of Diagnostic and Interventional Neuroradiology, Inselspital, University Hospital and University of Bern, Bern, Switzerland
| | - Urs Fischer
- Department of Neurology, Inselspital, University Hospital and University of Bern, Bern, Switzerland.,Department of Neurology, University Hospital and University of Basel, Basel, Switzerland
| | - Jan Gralla
- Institute of Diagnostic and Interventional Neuroradiology, Inselspital, University Hospital and University of Bern, Bern, Switzerland
| | - Hakan Sarikaya
- Department of Neurology, Inselspital, University Hospital and University of Bern, Bern, Switzerland
| | | | - Kateryna Antonenko
- Department of Neurology, Inselspital, University Hospital and University of Bern, Bern, Switzerland.,Department of Neurology, Bogomolets National Medical University, Kyiv, Ukraine
| | - Roza M Umarova
- Department of Neurology, Inselspital, University Hospital and University of Bern, Bern, Switzerland
| | - Lia Bally
- Department of Diabetes, Endocrinology, Clinical Nutrition and Metabolism, Inselspital, University Hospital and University of Bern, Bern, Switzerland
| | - Marcel Arnold
- Department of Neurology, Inselspital, University Hospital and University of Bern, Bern, Switzerland
| | - Mirjam R Heldner
- Department of Neurology, Inselspital, University Hospital and University of Bern, Bern, Switzerland
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22
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Janvier P, Kerleroux B, Turc G, Pasi M, Farhat W, Bricout N, Benzakoun J, Legrand L, Clarençon F, Bracard S, Oppenheim C, Boulouis G, Henon H, Naggara O, Ben Hassen W. TAGE Score for Symptomatic Intracranial Hemorrhage Prediction After Successful Endovascular Treatment in Acute Ischemic Stroke. Stroke 2022; 53:2809-2817. [PMID: 35698971 DOI: 10.1161/strokeaha.121.038088] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Determine if early venous filling (EVF) after complete successful recanalization with mechanical thrombectomy in acute ischemic stroke is an independent predictor of symptomatic intracranial hemorrhage (sICH) and integrate EVF into a risk score for sICH prediction. METHODS Consecutive patients with anterior acute ischemic stroke treated by mechanical thrombectomy issued from patients enrolled in the THRACE trial (Thrombectomie des Artères Cérébrales) and from 2 prospective registries were included and divided into a derivation (Center I; n=402) and validation cohorts (THRACE and center 2; n=507). EVF was evaluated by 2 blinded readers. sICH was defined according to the modified European cooperative acute stroke study II. Clinical and radiological data were analyzed in the derivation cohort (C1) to identify independent predictors of sICH and construct a predictive score test on the validation cohort (THRACE + C2). RESULTS Symptomatic ICH rate was similar between the two cohorts (9.9% and 8.9% respectively, P=0.9). Time from onset-to-successful recanalization >270 minutes (odds ratio [OR], 7.8 [95% CI, 2.5-24]), Alberta Stroke Program Early CT Score (≤5 [OR, 2.49 (95% CI, 1.8-8.1) or 6-7 [OR, 1.15 (95% CI, 1.03-4.46)]), glucose blood level >7 mmol/L (OR, 2.92 [95% CI, 1.26-6.7]), and EVF presence (OR, 11.9 [95% CI, 3.8-37.5]) were independent predictors of sICH and constituted the Time-Alberta Stroke Program Early CT-Glycemia-EVF score. Time-Alberta Stroke Program Early CT-Glycemia-EVF score was associated with an increased risk of sICH in the derivation cohort (OR increase per unit, 1.99 [95% CI, 1.53-2.59]; P<0.001) with area under the curve, 0.832 [95% CI, 0.767-0.898]. The score had good performance in the validation cohort (area under the curve, 0.801 [95% CI, 0.69-0.91]). CONCLUSIONS Time-Alberta Stroke Program Early CT-Glycemia-EVF score is a simple tool with readily available clinical variables with good performances for sICH prediction after mechanical thrombectomy. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifier: NCT01062698.
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Affiliation(s)
- Paul Janvier
- Department of Neuroradiology, Université de Paris, INSERM U1266, Institute of Psychiatry and Neuroscience of Paris, GHU-Paris Psychiatrie et Neurosciences, Hôpital Sainte Anne, France. (P.J., B.K., J.B., L.L., C.O., O.N., W.B.H.)
| | - Basile Kerleroux
- Department of Neuroradiology, Université de Paris, INSERM U1266, Institute of Psychiatry and Neuroscience of Paris, GHU-Paris Psychiatrie et Neurosciences, Hôpital Sainte Anne, France. (P.J., B.K., J.B., L.L., C.O., O.N., W.B.H.)
| | - Guillaume Turc
- Neurolog, Université de Paris, INSERM U1266, Institute of Psychiatry and Neuroscience of Paris, GHU-Paris Psychiatrie et Neurosciences, Hôpital Sainte Anne, France.y (G.T.)
| | - Marco Pasi
- Department of Neurology, Lille University, Inserm U1171, Degenerative and Vascular Cognitive Disorders, CHU Lille, France. (M.P., H.H.)
| | - Wassim Farhat
- Department of Neurology, Saint-Joseph Hospital, Paris, France (W.F.)
| | - Nicolas Bricout
- Department of Interventional Neuroradiology, Lille University, Inserm U1171, Degenerative and Vascular Cognitive Disorders, CHU Lille, France. (N.B.)
| | - Joseph Benzakoun
- Department of Neuroradiology, Université de Paris, INSERM U1266, Institute of Psychiatry and Neuroscience of Paris, GHU-Paris Psychiatrie et Neurosciences, Hôpital Sainte Anne, France. (P.J., B.K., J.B., L.L., C.O., O.N., W.B.H.)
| | - Laurence Legrand
- Department of Neuroradiology, Université de Paris, INSERM U1266, Institute of Psychiatry and Neuroscience of Paris, GHU-Paris Psychiatrie et Neurosciences, Hôpital Sainte Anne, France. (P.J., B.K., J.B., L.L., C.O., O.N., W.B.H.)
| | - Frédéric Clarençon
- Department of Neuroradiology, Sorbonne University, AP-HP, Pitié Salpêtrière - Charles Foix Hospital, Paris, France (F.C.)
| | - Serge Bracard
- Department of Neuroradiology, Nancy University (S.B.)
| | - Catherine Oppenheim
- Department of Neuroradiology, Université de Paris, INSERM U1266, Institute of Psychiatry and Neuroscience of Paris, GHU-Paris Psychiatrie et Neurosciences, Hôpital Sainte Anne, France. (P.J., B.K., J.B., L.L., C.O., O.N., W.B.H.)
| | - Grégoire Boulouis
- Diagnostic and Interventional Neuroradiology Department, INSERM U1253 iBrain, University Hospital of Tours, Centre Val de Loire Region, France (G.B.)
| | - Hilde Henon
- Department of Neurology, Lille University, Inserm U1171, Degenerative and Vascular Cognitive Disorders, CHU Lille, France. (M.P., H.H.)
| | - Olivier Naggara
- Department of Neuroradiology, Université de Paris, INSERM U1266, Institute of Psychiatry and Neuroscience of Paris, GHU-Paris Psychiatrie et Neurosciences, Hôpital Sainte Anne, France. (P.J., B.K., J.B., L.L., C.O., O.N., W.B.H.)
| | - Wagih Ben Hassen
- Department of Neuroradiology, Université de Paris, INSERM U1266, Institute of Psychiatry and Neuroscience of Paris, GHU-Paris Psychiatrie et Neurosciences, Hôpital Sainte Anne, France. (P.J., B.K., J.B., L.L., C.O., O.N., W.B.H.)
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23
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Dehondt JD, Holay Q, Brohee S, Mourre H, Hak JF, Osman O, Suissa L, Doche E. Diabetes is an Independent Growth Factor of Ischemic Stroke During Reperfusion Phase Leading to Poor Clinical Outcome. J Stroke Cerebrovasc Dis 2022; 31:106477. [PMID: 35472652 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 03/16/2022] [Accepted: 03/24/2022] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVES Despite the success of recanalization by bridging therapy, about half of treated stroke patients remain disabled. While numerous reports propose clinical predictors of stroke clinical outcome in this context, we originally aimed to study pre-therapeutic factors influencing infarct growth (IG) and poor clinical outcome in strokes due to large vessel occlusion (LVO) successfully recanalized. MATERIALS AND METHODS We enrolled 87 consecutive successfully recanalized patients (mTICI: 2b/2c/3) by mechanical thrombectomy (±rt-PA) after stroke due to middle cerebral artery (M1) occlusion within 6 h according to AHA guidelines. IG was defined by subtracting the initial DWI volume to the final 24 h-TDM volume. Statistical associations between poor clinical outcome (mRS≥2), IG and pertinent clinico-radiological variables, were measured using logistic and linear regression models. RESULTS Among 87 enrolled patients (Age(y): 68.4 ± 17.5; NIHSS: 16.0 ± 5.4), 42/87 (48,28%) patients had a mRS ≥ 2 at 3 months. Diabetic history (OR: 3.70 CI95%[1.03;14.29] and initial NIHSS (/1 point: OR: 1.16 CI95%[1.05;1.27]) were independently associated with poor outcome. IG was significantly higher in stroke patients with poor outcome (+7.57 ± 4.52 vs -7.81 ± 1.67; p = 0.0024). Initial volumes were not significantly different (mRS≥2: 16.18 ± 2.67; mRS[0-1]: 14.70 ± 2.30; p = 0.6771). Explanatory variables of IG in linear regression were diabetic history (β: 21.26 CI95%[5.43; 37.09]) and NIHSS (β: 0.83 CI95%[0.02; 1.64]). IG was higher in diabetic stroke patients (23.54 ± 1.43 vs -6.20 ± 9.36; p = 0.0061). CONCLUSIONS We conclude that diabetes leads to continued IG after complete recanalization, conditioning clinical outcome in LVO strokes successfully recanalized by bridging therapy. We suggest that poor tissular reperfusion by diabetic microangiopathy could explain this result.
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Affiliation(s)
- Jean-Daniel Dehondt
- Stroke Unit, University Hospital of Marseille (AP-HM), Marseille, France; Center for Cardiovascular and Nutrition Research (C2VN), Aix Marseille University, Marseille, France
| | | | - Sacha Brohee
- Stroke Unit, University Hospital of Marseille (AP-HM), Marseille, France
| | - Hélène Mourre
- Stroke Unit, University Hospital of Marseille (AP-HM), Marseille, France
| | - Jean-François Hak
- Neuroradiology Department, University Hospital of Marseille (AP-HM), Marseille, France
| | - Ophélie Osman
- Stroke Unit, University Hospital of Marseille (AP-HM), Marseille, France
| | - Laurent Suissa
- Stroke Unit, University Hospital of Marseille (AP-HM), Marseille, France; Center for Cardiovascular and Nutrition Research (C2VN), Aix Marseille University, Marseille, France
| | - Emilie Doche
- Stroke Unit, University Hospital of Marseille (AP-HM), Marseille, France; Center for Cardiovascular and Nutrition Research (C2VN), Aix Marseille University, Marseille, France.
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Li H, Huang J, Ye S, Chen H, Yuan L, Liao G, Du W, Li C, Fang L, Liu S, Yang P, Zhang Y, Xing P, Zhang X, Ye X, Peng Y, Cao J, Zhang L, Yang Z, Liu J. Predictors of mortality in acute ischemic stroke treated with endovascular thrombectomy despite successful reperfusion: subgroup analysis of a multicentre randomised clinical trial. BMJ Open 2022; 12:e053765. [PMID: 35232782 PMCID: PMC8889322 DOI: 10.1136/bmjopen-2021-053765] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES We sought to determine the predictors of 90-day mortality despite successful reperfusion. DESIGN Subgroup analysis of a multicentre randomised clinical trial (ClinicalTrials.gov Identifier: NCT03469206). SETTING This study used data from the Direct Intra-arterial thrombectomy in order to Revascularize AIS patients with large vessel occlusion Efficiently in Chinese Tertiary hospitals: a Multicenter randomized clinical Trial (DIRECT-MT). PARTICIPANTS 622 patients enrolled in DIRECT-MT. RESULTS Overall successful reperfusion rate was 82.0% (510/622), and 18.5% (115/622) of patients died within 90 days. Univariate analysis identified increased risks of mortality for age ≥70 years, history of diabetes mellitus, National Institutes of Health Stroke Scale (NIHSS) score on admission ≥17, NIHSS score after thrombectomy (24±6 hours) ≥11, Alberta Stroke Program Early Computed Tomography Score (ASPECTS) <9, glucose level at hospital arrival ≥130 mg/dL, location of internal carotid artery occlusion, embolisation into a new territory, symptomatic intracranial haemorrhage (ICH) and a decreased risk of mortality for smoking. In multivariable analysis, smoking (OR 0.38; 95% CI 0.17 to 0.83; p=0.015), NIHSS score on admission ≥17 (OR 3.14; 95% CI 1.77 to 5.55; p<0.001), glucose level at hospital arrival ≥130 mg/dL (OR 2.54; 95% CI 1.51 to 4.27; p<0.001), symptomatic ICH (OR 11.70; 95% CI 4.74 to 28.89; p<0.001) and NIHSS score after thrombectomy (24±6 hours) ≥11 (OR 12.04; 95% CI 5.09 to 28.46; p<0.001) were significant independent predictors of 90-day mortality. CONCLUSIONS Symptomatic ICH and high post-thrombectomy NIHSS score are strong predictor of 90-day mortality in acute ischaemic stroke treated with mechanical thrombectomy despite successful reperfusion, as well as high NIHSS score and high glucose level at hospital arrival. However, further studies need to be performed to confirm the association between smoking and mortality.
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Affiliation(s)
- Hao Li
- Department of Neurology, Maoming People's Hospital, Maoming, China
| | - Jinbo Huang
- Department of Neurology, Maoming People's Hospital, Maoming, China
| | - Shisheng Ye
- Department of Neurology, Maoming People's Hospital, Maoming, China
| | - Hai Chen
- Department of Neurology, Maoming People's Hospital, Maoming, China
| | - Li Yuan
- Department of Neurology, Maoming People's Hospital, Maoming, China
| | - Geng Liao
- Department of Neurology, Maoming People's Hospital, Maoming, China
| | - Weijie Du
- Department of Neurology, Maoming People's Hospital, Maoming, China
| | - Chaomao Li
- Department of Neurology, Maoming People's Hospital, Maoming, China
| | - Ling Fang
- Department of Neurology, Maoming People's Hospital, Maoming, China
| | - Sheng Liu
- Department of Radiology, Jiangsu Provincial People's Hospital of Nanjing Medical University, Nanjing, China
| | - Pengfei Yang
- Department of Neurosurgery, Naval Medical University Changhai hospital, Shanghai, China
| | - Yongwei Zhang
- Department of Neurology, Naval Medical University Changhai hospital, Shanghai, China
| | - Pengfei Xing
- Department of Neurology, Naval Medical University Changhai hospital, Shanghai, China
| | - Xiaoxi Zhang
- Department of Neurosurgery, Naval Medical University Changhai hospital, Shanghai, China
| | - Xiaofei Ye
- Department of Statistics, Naval Medical University, Shanghai, China
| | - Ya Peng
- Department of Neurosurgery, Changzhou No. 1 People's Hospital, Changzhou, China
| | - Jie Cao
- Department of Neurosurgery, Changzhou First People's Hospital, Changzhou, China
| | - Liyong Zhang
- Department of Neurosurgery, Liaocheng People's Hospital, Liaocheng City, Shandong, China
| | - Zhi Yang
- Department of Neurology, Maoming People's Hospital, Maoming, China
| | - Jianmin Liu
- Department of Neurosurgery, Naval Medical University Changhai hospital, Shanghai, China
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25
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Preoperative plasma D-dimer level may be predictive for success of cerebral reperfusion and outcome after emergency mechanical thrombectomy for intracranial large vessel occlusion. J Clin Neurosci 2022; 97:75-81. [DOI: 10.1016/j.jocn.2021.12.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 12/08/2021] [Accepted: 12/27/2021] [Indexed: 11/24/2022]
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26
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Wang A, Cui T, Wang C, Zhu Q, Zhang X, Li S, Yang Y, Shang W, Wu B. Prognostic Significance of Admission Glucose Combined with Hemoglobin A1c in Acute Ischemic Stroke Patients with Reperfusion Therapy. Brain Sci 2022; 12:brainsci12020294. [PMID: 35204058 PMCID: PMC8869904 DOI: 10.3390/brainsci12020294] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 02/07/2022] [Accepted: 02/12/2022] [Indexed: 02/05/2023] Open
Abstract
Background: Elevated admission glucose and hemoglobin A1c (HbA1c) levels have been suggested to be associated with 90-day functional outcomes in acute ischemic stroke (AIS) patients with endovascular thrombectomy (EVT). However, whether the prognostic significance of admission glucose and that of HbA1c have a joint effect on patients with intravascular thrombolysis (IVT) and/or EVT remains unclear. This study aimed to explore the association between admission glucose combined with HbA1c and outcomes in patients with reperfusion therapy. Methods: Consecutive AIS patients treated with IVT and/or EVT between 2 January 2018 and 27 February 2021 in West China hospital were enrolled. Admission glucose and HbA1c levels were measured at admission. Participants were divided into four groups according to admission glucose level (categorical variable: <7.8 and ≥7.8 mmol/L) and HbA1c level (categorical variable: <6.5% and ≥6.5%): normal glucose and normal HbA1c (NGNA), normal glucose and high HbA1c (NGHA), high glucose and normal HbA1c (HGNA), and high glucose and high HbA1c (HGHA). The primary outcome was an unfavorable functional outcome defined as a modified Rankin Scale (mRS) ≥ 3. The secondary outcome was all-cause mortality at 90 days. Results: A total of 519 patients (mean age, 69.0 ± 13.4 years; 53.8% males) were included. Patients in the HGHA group had a significantly increased risk of unfavorable functional outcome (OR, 1.81; 95%CI, 1.01–3.23) and mortality (OR, 1.75; 95%CI, 1.01–3.06) at 90 days compared with those in the NGNA group after adjustment for confounders. There was no significant association between NGHA (OR, 0.43; 95%CI, 0.12–1.53) or HGNA (OR, 1.46; 95%CI, 0.84–2.56) and outcomes compared to the NGNA group. Conclusion: The combination of high admission glucose and high HbA1c level was significantly associated with unfavorable functional outcome and mortality at 90 days in AIS patients with reperfusion therapy.
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Affiliation(s)
- Anmo Wang
- Center of Cerebrovascular Diseases, Department of Neurology, West China Hospital, Sichuan University, Chengdu 610041, China; (A.W.); (T.C.); (X.Z.); (S.L.); (Y.Y.); (W.S.)
| | - Ting Cui
- Center of Cerebrovascular Diseases, Department of Neurology, West China Hospital, Sichuan University, Chengdu 610041, China; (A.W.); (T.C.); (X.Z.); (S.L.); (Y.Y.); (W.S.)
| | - Changyi Wang
- Department of Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu 610041, China;
| | - Qiange Zhu
- The Second Department of Neurology, Shanxi Provincial People’s Hospital, Xi’an 710068, China;
| | - Xuening Zhang
- Center of Cerebrovascular Diseases, Department of Neurology, West China Hospital, Sichuan University, Chengdu 610041, China; (A.W.); (T.C.); (X.Z.); (S.L.); (Y.Y.); (W.S.)
| | - Shucheng Li
- Center of Cerebrovascular Diseases, Department of Neurology, West China Hospital, Sichuan University, Chengdu 610041, China; (A.W.); (T.C.); (X.Z.); (S.L.); (Y.Y.); (W.S.)
| | - Yuan Yang
- Center of Cerebrovascular Diseases, Department of Neurology, West China Hospital, Sichuan University, Chengdu 610041, China; (A.W.); (T.C.); (X.Z.); (S.L.); (Y.Y.); (W.S.)
| | - Wenzuo Shang
- Center of Cerebrovascular Diseases, Department of Neurology, West China Hospital, Sichuan University, Chengdu 610041, China; (A.W.); (T.C.); (X.Z.); (S.L.); (Y.Y.); (W.S.)
| | - Bo Wu
- Center of Cerebrovascular Diseases, Department of Neurology, West China Hospital, Sichuan University, Chengdu 610041, China; (A.W.); (T.C.); (X.Z.); (S.L.); (Y.Y.); (W.S.)
- Correspondence: ; Tel.: +86-189-8060-2142
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27
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Risk Score for Symptomatic Intracranial Haemorrhage in Patients with Acute Ischaemic Stroke Receiving Endovascular Treatment. Clin Neurol Neurosurg 2022; 215:107184. [DOI: 10.1016/j.clineuro.2022.107184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 02/19/2022] [Accepted: 02/22/2022] [Indexed: 11/18/2022]
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28
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Mi D, Li Z, Gu H, Jiang Y, Zhao X, Wang Y, Wang Y. Stress hyperglycemia is associated with in-hospital mortality in patients with diabetes and acute ischemic stroke. CNS Neurosci Ther 2022; 28:372-381. [PMID: 35084107 PMCID: PMC8841306 DOI: 10.1111/cns.13764] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 10/19/2021] [Accepted: 11/05/2021] [Indexed: 12/12/2022] Open
Abstract
Background and Objective Stress hyperglycemia may occur in diabetic patients with acute severe cerebrovascular disease, but the results regarding its association with stroke outcomes are conflicting. This study aimed to examine the association between stress‐induced hyperglycemia and the occurrence of in‐hospital death in patients with diabetes and acute ischemic stroke. Research Design and Methods All data were from the Chinese Stroke Center Alliance (CSCA) database and were collected between 2016 and 2018 from >300 centers across China. Patients’ demographics, clinical presentation, and laboratory data were extracted from the database. The primary endpoint was in‐hospital death. The ratio of fasting blood glucose (FBG) to HbA1c was calculated, that is, the stress‐induced hyperglycemia ratio (SHR), to determine stress hyperglycemia following acute ischemic stroke. Results A total of 168,381 patients were included. The mean age was 66.2 ± 10.7, and 77,688 (43.0%) patients were female. The patients were divided into two groups: survivors (n = 167,499) and non‐survivors (n = 882), as well as into four groups according to their SHR quartiles (n = 42,090–42,099/quartile). There were 109 (0.26%), 142 (0.34%), 196 (0.47%), and 435 (1.03%) patients who died in the Q1, Q2, Q3, and Q4 quartiles, respectively. Compared with Q1 patients, the death risk was higher in Q4 patients (odds ratio (OR) = 4.02) (adjusted OR = 1.80, 95% confidence interval [CI] = 1.10–2.92, p = 0.018 after adjustment for traditional cardiovascular risk factors). The ROC analyses showed that SHR (AUC = 0.667, 95% CI: 0.647–0.686) had a better predictive value for mortality than that of fasting blood glucose (AUC = 0.633, 95% CI: 0.613–0.652) and HbA1c (AUC = 0.523, 95% CI: 0.504–0.543). Conclusions The SHR may serve as an accessory parameter for the prognosis of patients with diabetes after acute ischemic stroke. Hyperglycemia in stroke patients with diabetes mellitus is associated with a higher risk of in‐hospital death.
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Affiliation(s)
- Donghua Mi
- Department of Vascular Neurology, Beijing Tiantan Hospital, Capital, Medical University, Beijing, China
| | - Zixiao Li
- Department of Vascular Neurology, Beijing Tiantan Hospital, Capital, Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Hongqiu Gu
- Department of Vascular Neurology, Beijing Tiantan Hospital, Capital, Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Tiantan Clinical Trial and Research Center for Stroke, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yingyu Jiang
- China National Clinical Research Center for Neurological Diseases, Beijing, China.,Tiantan Clinical Trial and Research Center for Stroke, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xingquan Zhao
- Department of Vascular Neurology, Beijing Tiantan Hospital, Capital, Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Yilong Wang
- Department of Vascular Neurology, Beijing Tiantan Hospital, Capital, Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Tiantan Clinical Trial and Research Center for Stroke, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yongjun Wang
- Department of Vascular Neurology, Beijing Tiantan Hospital, Capital, Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Tiantan Clinical Trial and Research Center for Stroke, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Center for Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
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29
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Cannarsa GJ, Wessell AP, Chryssikos T, Stokum JA, Kim K, De Paula Carvalho H, Miller TR, Morris N, Badjatia N, Chaturvedi S, Gandhi D, Simard JM, Jindal G. Initial Stress Hyperglycemia Is Associated With Malignant Cerebral Edema, Hemorrhage, and Poor Functional Outcome After Mechanical Thrombectomy. Neurosurgery 2022; 90:66-71. [PMID: 34982872 DOI: 10.1227/neu.0000000000001735] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 08/10/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Malignant cerebral edema (MCE) and intracranial hemorrhage (ICH) are associated with poor neurological outcomes despite revascularization after mechanical thrombectomy (MT). The factors associated with the development of MCE and ICH after MT are not well understood. OBJECTIVE To determine periprocedural factors associated with MCE, ICH, and poor functional outcome. METHODS We retrospectively analyzed anterior cerebral circulation large vessel occlusion cases that underwent MT from 2012 to 2019 at a single Comprehensive Stroke Center. Multivariate logistic regression analyses were performed to determine significant predictors of MCE, ICH, and poor functional outcome (modified Rankin Scale, 3-6) at 90 d. RESULTS Four hundred patients were included. Significant independent predictors of MCE after MT included initial stress glucose ratio (iSGR) (odds ratio [OR], 14.26; 95% CI, 3.82-53.26; P < .001), National Institutes of Health Stroke Scale (NIHSS) (OR, 1.10; 95% CI, 1.03-1.18; P = .008), internal carotid artery compared with M1 or M2 occlusion, and absence of successful revascularization (OR, 0.16; 95% CI, 0.06-0.44; P < .001). Significant independent predictors of poor functional outcome included MCE (OR, 7.47; 95% CI, 2.20-25.37; P = .001), iSGR (OR, 5.15; 95% CI, 1.82-14.53; P = .002), ICH (OR, 4.77; 95% CI, 1.20-18.69; P = .024), NIHSS (OR, 1.10; 95% CI, 1.05-1.16; P < .001), age (OR, 1.04; 95% CI, 1.03-1.07; P < .001), and thrombolysis in cerebral infarction 2C/3 recanalization (OR, 0.12; 95% CI, 0.05-0.29; P < .001). CONCLUSION Elevated iSGR significantly increases the risk of MCE and ICH and is an independent predictor of poor functional outcome. Thrombolysis in cerebral infarction 2C/3 revascularization is associated with reduced risk of MCE, ICH, and poor functional outcome. Whether stress hyperglycemia represents a modifiable risk factor is uncertain, and further investigation is warranted.
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Affiliation(s)
- Gregory J Cannarsa
- Department of Neurosurgery, University of Maryland Medical Center, Baltimore, Maryland, USA
| | - Aaron P Wessell
- Department of Neurosurgery, University of Maryland Medical Center, Baltimore, Maryland, USA
| | - Timothy Chryssikos
- Department of Neurosurgery, University of Maryland Medical Center, Baltimore, Maryland, USA
| | - Jesse A Stokum
- Department of Neurosurgery, University of Maryland Medical Center, Baltimore, Maryland, USA
| | - Kevin Kim
- University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Helio De Paula Carvalho
- Division of Interventional Neuroradiology, University of Maryland Medical Center, Baltimore, Maryland, USA
| | - Timothy R Miller
- Division of Interventional Neuroradiology, University of Maryland Medical Center, Baltimore, Maryland, USA
| | - Nicholas Morris
- Program in Trauma, Department of Neurology, University of Maryland Medical Center, Baltimore, Maryland, USA
| | - Neeraj Badjatia
- Program in Trauma, Department of Neurology, University of Maryland Medical Center, Baltimore, Maryland, USA
| | - Seemant Chaturvedi
- Program in Trauma, Department of Neurology, University of Maryland Medical Center, Baltimore, Maryland, USA
| | - Dheeraj Gandhi
- Division of Interventional Neuroradiology, University of Maryland Medical Center, Baltimore, Maryland, USA
| | - J Marc Simard
- Department of Neurosurgery, University of Maryland Medical Center, Baltimore, Maryland, USA
| | - Gaurav Jindal
- Division of Interventional Neuroradiology, University of Maryland Medical Center, Baltimore, Maryland, USA
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30
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Merlino G, Pez S, Gigli GL, Sponza M, Lorenzut S, Surcinelli A, Smeralda C, Valente M. Stress Hyperglycemia in Patients With Acute Ischemic Stroke Due to Large Vessel Occlusion Undergoing Mechanical Thrombectomy. Front Neurol 2021; 12:725002. [PMID: 34659090 PMCID: PMC8511418 DOI: 10.3389/fneur.2021.725002] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 08/30/2021] [Indexed: 01/08/2023] Open
Abstract
Stress hyperglycemia may impair outcomes in patients with acute ischemic stroke (AIS) undergoing mechanical thrombectomy (MT). The glucose-to-glycated hemoglobin ratio (GAR) was used to measure stress hyperglycemia. Data from our database of consecutive patients admitted to the Udine University Hospital with AIS who were treated with MT between January 2015 and December 2020 were retrospectively analyzed. We included 204 patients in the study and stratified them into four groups according to the quartiles of GAR (Q1-Q4). The higher the GAR index, the more severe the stress hyperglycemia was considered. Patients with more severe stress hyperglycemia showed a higher prevalence of 3-month poor outcome (Q1, 53.1%; Q2, 40.4%; Q3, 63.5%; Q4, 82.4%; p = 0.001), 3-month mortality (Q1, 14.3%; Q2, 11.5%; Q3, 15.4%; Q4, 31.4%; p = 0.001), and symptomatic intracranial hemorrhage (Q1, 2%; Q2, 7.7%; Q3, 7.7%; Q4, 25.4%; p = 0.001). After controlling for several confounders, severe stress hyperglycemia remained a significant predictor of 3-month poor outcome (OR 4.52, 95% CI 1.4-14.62, p = 0.012), 3-month mortality (OR 3.55, 95% CI 1.02-12.29, p = 0.046), and symptomatic intracranial hemorrhage (OR 6.89, 95% CI 1.87-25.36, p = 0.004). In summary, stress hyperglycemia, as measured by the GAR index, is associated with a detrimental effect in patients with AIS undergoing MT.
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Affiliation(s)
- Giovanni Merlino
- Stroke Unit, Department of Neuroscience, Udine University Hospital, Udine, Italy.,Clinical Neurology, Udine University Hospital, Udine, Italy
| | - Sara Pez
- Clinical Neurology, Udine University Hospital, Udine, Italy.,Dipartimento di Area Medica (DAME), University of Udine, Udine, Italy
| | - Gian Luigi Gigli
- Clinical Neurology, Udine University Hospital, Udine, Italy.,Dipartimento di Area Medica (DAME), University of Udine, Udine, Italy
| | - Massimo Sponza
- Division of Vascular and Interventional Radiology, Udine University Hospital, Udine, Italy
| | - Simone Lorenzut
- Stroke Unit, Department of Neuroscience, Udine University Hospital, Udine, Italy
| | - Andrea Surcinelli
- Clinical Neurology, Udine University Hospital, Udine, Italy.,Dipartimento di Area Medica (DAME), University of Udine, Udine, Italy
| | - Carmelo Smeralda
- Clinical Neurology, Udine University Hospital, Udine, Italy.,Dipartimento di Area Medica (DAME), University of Udine, Udine, Italy
| | - Mariarosaria Valente
- Clinical Neurology, Udine University Hospital, Udine, Italy.,Dipartimento di Area Medica (DAME), University of Udine, Udine, Italy
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31
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Puz P, Stryjewska-Makuch G, Żak A, Rybicki W, Student S, Lasek-Bal A. Prognostic Role of Chronic Rhinosinusitis in Acute Ischemic Stroke Patients Undergoing Mechanical Thrombectomy. J Clin Med 2021; 10:jcm10194446. [PMID: 34640464 PMCID: PMC8509423 DOI: 10.3390/jcm10194446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 09/07/2021] [Accepted: 09/24/2021] [Indexed: 11/16/2022] Open
Abstract
Background: The aim of the study was to assess the relevance of chronic rhinosinusitis (CRS) CT features to the efficacy of mechanical thrombectomy (MT) in patients with acute ischemic stroke. Methods: This study included 311 patients qualified for MT in whom the CRS features were assessed based on a CT scan, according to the Lund-Mackay (L-M) score. Clinical, inflammatory parameters, patients neurological (NIHSS) and functional status (mRS), and recanalisation efficacy (TICI) were compared between patients with mild lesions (L-M score 0–3 points)-group 1, and patients with more severe lesions (L–M score 4–24)-group 2. Results: There was a significant difference in the NIHSS on day seven after stroke onset-10 points in group 1 and 14 points in group 2, p = 0.02. NIHSS ≤ 6 points on day seven was found in 41.9% of patients in group 1, and in 27.5% in group 2, p = 0.042. There were no significant differences in mRS score and in the TICI score. L-M score, lipid abnormalities and CRP were factors associated with NIHSS ≥ 7 points on day 7. Conclusions: The CT features of CRS may be used as a prognostic tool for early prognosis assessment in stroke patients.
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Affiliation(s)
- Przemysław Puz
- Department of Neurology, School of Health Sciences, Medical University of Silesia, ul. Ziołowa 45, 40-653 Katowice, Poland; (A.Ż.); (A.L.-B.)
- Department of Neurology, Leszek Giec Upper-Silesian Medical Centre, Silesian Medical University, ul. Ziołowa 45, 40-653 Katowice, Poland;
- Correspondence: ; Tel.: +48-323598306
| | - Grażyna Stryjewska-Makuch
- Department of Laryngology and Laryngological Oncology, Leszek Giec Upper-Silesian Medical Centre, Silesian Medical University, ul. Ziołowa 45, 40-653 Katowice, Poland;
| | - Amadeusz Żak
- Department of Neurology, School of Health Sciences, Medical University of Silesia, ul. Ziołowa 45, 40-653 Katowice, Poland; (A.Ż.); (A.L.-B.)
- Department of Neurology, Leszek Giec Upper-Silesian Medical Centre, Silesian Medical University, ul. Ziołowa 45, 40-653 Katowice, Poland;
| | - Wiktor Rybicki
- Department of Neurology, Leszek Giec Upper-Silesian Medical Centre, Silesian Medical University, ul. Ziołowa 45, 40-653 Katowice, Poland;
| | - Sebastian Student
- Biotechnology Center, Faculty of Automatic Control, Electronics and Computer Science, Silesian University of Technology, ul. Akademicka 16, 44-100 Gliwice, Poland;
| | - Anetta Lasek-Bal
- Department of Neurology, School of Health Sciences, Medical University of Silesia, ul. Ziołowa 45, 40-653 Katowice, Poland; (A.Ż.); (A.L.-B.)
- Department of Neurology, Leszek Giec Upper-Silesian Medical Centre, Silesian Medical University, ul. Ziołowa 45, 40-653 Katowice, Poland;
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32
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Chang JY, Kim WJ, Kwon JH, Kim BJ, Kim JT, Lee J, Cha JK, Kim DH, Cho YJ, Hong KS, Lee SJ, Park JM, Lee BC, Oh MS, Lee SH, Kim C, Kim DE, Lee KB, Park TH, Choi JC, Shin DI, Sohn SI, Hong JH, Lee JS, Bae HJ, Han MK. Prestroke Glucose Control and Functional Outcome in Patients With Acute Large Vessel Occlusive Stroke and Diabetes After Thrombectomy. Diabetes Care 2021; 44:2140-2148. [PMID: 34215632 PMCID: PMC8740925 DOI: 10.2337/dc21-0271] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 05/26/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To evaluate whether prestroke glucose control is associated with functional outcomes in patients with acute large vessel occlusive stroke and diabetes who underwent intra-arterial thrombectomy (IAT). RESEARCH DESIGN AND METHODS From the Clinical Research Center for Stroke-Korea registry, we included patients with emergent large vessel occlusive stroke with diabetes who underwent IAT between January 2009 and March 2020. The association between the HbA1c level at admission and functional outcomes (modified Rankin Scale at 3 months after the index stroke) was assessed. RESULTS A total of 1,351 patients were analyzed. Early neurological deterioration was more common in patients with higher levels of HbA1c at admission (P = 0.02 according to HbA1c quintiles, P = 0.003 according to an HbA1c cutoff value of 7.0%) than in those with lower HbA1c levels. Higher HbA1c levels at admission were significantly associated with decreased odds of favorable functional outcomes at a threshold of 7.0-7.1%. The association was consistently observed in subgroups divided according to age, sex, stroke subtype, occlusion site, degree of recanalization, thrombolysis modalities, time from symptom onset to groin puncture, and treatment period. CONCLUSIONS Prestroke glucose control with a target HbA1c of ≤7.0% may be beneficial for neurological recovery in patients with diabetes undergoing IAT for large vessel occlusive stroke, regardless of stroke subtype, bridging intravenous thrombolysis, occlusion site, degree of recanalization, and treatment period.
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Affiliation(s)
- Jun Young Chang
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Wook-Joo Kim
- Department of Neurology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Ji Hyun Kwon
- Department of Neurology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Beom Joon Kim
- Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Joon-Tae Kim
- Department of Neurology, Chonnam National University Hospital, Gwangju, Korea
| | - Jun Lee
- Department of Neurology, Yeungnam University Hospital, Daegu, Korea
| | - Jae Kwan Cha
- Department of Neurology, Dong-A University Hospital, Busan, Korea
| | - Dae-Hyun Kim
- Department of Neurology, Dong-A University Hospital, Busan, Korea
| | - Yong-Jin Cho
- Department of Neurology, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Keun-Sik Hong
- Department of Neurology, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Soo Joo Lee
- Department of Neurology, Eulji University Hospital, Daejeon, Korea
| | - Jong-Moo Park
- Department of Neurology, Nowon Eulji Medical Center, Eulji University, Seoul, Korea
| | - Byung-Chul Lee
- Department of Neurology, Hallym University College of Medicine, Pyeongchon, Korea
| | - Mi Sun Oh
- Department of Neurology, Hallym University College of Medicine, Pyeongchon, Korea
| | - Sang-Hwa Lee
- Department of Neurology, Hallym University College of Medicine, Pyeongchon, Korea
| | - Chulho Kim
- Department of Neurology, Hallym University College of Medicine, Pyeongchon, Korea
| | - Dong-Eog Kim
- Department of Neurology, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Kyung Bok Lee
- Department of Neurology, Soonchunhyang University Hospital, Seoul, Korea
| | - Tae Hwan Park
- Department of Neurology, Seoul Medical Center, Seoul, Korea
| | - Jay Chol Choi
- Department of Neurology, Jeju National University Hospital, Jeju, Korea
| | - Dong-Ick Shin
- Department of Neurology, Chungbuk National University Hospital, Cheongju, Korea
| | - Sung-Il Sohn
- Department of Neurology, Keimyung University Dongsan Medical Center, Daegu, Korea
| | - Jeong-Ho Hong
- Department of Neurology, Keimyung University Dongsan Medical Center, Daegu, Korea
| | - Ji Sung Lee
- Clinical Research Center, Asan Medical Center, Seoul, Korea
| | - Hee-Joon Bae
- Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Moon-Ku Han
- Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
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Perez-Vega C, Domingo RA, Tripathi S, Ramos-Fresnedo A, Kashyap S, Quinones-Hinojosa A, Lin MP, Fox WC, Tawk RG. Influence of glucose levels on clinical outcome after mechanical thrombectomy for large-vessel occlusion: a systematic review and meta-analysis. J Neurointerv Surg 2021; 14:neurintsurg-2021-017771. [PMID: 34362794 DOI: 10.1136/neurintsurg-2021-017771] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 06/16/2021] [Indexed: 12/29/2022]
Abstract
Mechanical thrombectomy (MT) represents the mainstay of treatment for patients with acute ischemic stroke due to large-vessel occlusion (LVO). Intravenous thrombolysis has been associated with worse clinical outcome in patients presenting with high blood glucose levels at admission; to date the true effect of hyperglycemia in the setting of MT has not been fully elucidated. In this meta-analysis, we analyzed the influence of high blood glucose levels at admission on clinical outcome after MT. Ovid EMBASE, PubMed, Scopus, and Cochrane Library databases were searched from their dates of inception up to March 2021. An initial search identified 2118 articles representing 1235 unique studies. After applying selection criteria, three prospective and five retrospective studies were analyzed, yielding a pooled cohort of 5861 patients (2041 who presented with hyperglycemia, and 3820 who presented with normal blood glucose levels). Patients in the hyperglycemia group were less likely to have a modified Ranking Scale (mRS) score <3 (risk ratio (RR): 0.65; 95% CI 0.59 to 0.72; p<0.0001; I 2=13%), and had an increased risk of symptomatic intracranial hemorrhage (sICH) (RR: 2.07; 95% CI 1.65 to 2.60; p<0.0001; I 2=0%) and mortality (RR: 1.73; 95% CI 1.57 to 1.91; p<0.0001; I 2=0%). Patients who present with hyperglycemia and undergo MT for treatment of LVO have an increased risk of unfavorable clinical outcome, sICH, and mortality. Glucose levels at admission appear to be a prognostic factor in this subset of patients. Further studies should focus on evaluating control of the glucose level at admission as a modifiable risk factor in patients undergoing MT for LVO.
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Affiliation(s)
- Carlos Perez-Vega
- Department of Neurologic Surgery, Mayo Clinic, Jacksonville, Florida, USA
| | - Ricardo A Domingo
- Department of Neurologic Surgery, Mayo Clinic, Jacksonville, Florida, USA
| | - Shashwat Tripathi
- Department of Neurologic Surgery, Mayo Clinic, Jacksonville, Florida, USA.,Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | | | - Samir Kashyap
- Department of Neurosurgery, Riverside University Health System, Riverside, California, USA
| | | | - Michelle P Lin
- Department of Neurology, Mayo Clinic, Jacksonville, Florida, USA
| | - W Christopher Fox
- Department of Neurologic Surgery, Mayo Clinic, Jacksonville, Florida, USA
| | - Rabih G Tawk
- Department of Neurologic Surgery, Mayo Clinic, Jacksonville, Florida, USA
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34
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Effect of Intensive Glucose Control on Outcomes of Hyperglycemic Stroke Patients Receiving Mechanical Thrombectomy: Secondary Analysis of the SHINE Trial. J Neurosurg Anesthesiol 2021; 34:415-418. [PMID: 34354023 DOI: 10.1097/ana.0000000000000795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 07/06/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Hyperglycemia is common among patients presenting with acute ischemic stroke (AIS) and is associated with poor clinical outcomes. We studied the effects of intensive blood glucose control among AIS patients presenting with hyperglycemia treated with mechanical thrombectomy (MT). METHODS We analyzed publicly available data from the Stroke Hyperglycemia Insulin Network Effort trial. In this nonpreplanned secondary analysis, we compared hyperglycemic AIS patients treated with MT who received intensive blood glucose control (80 to 130 mg/dL) with those who received standard blood glucose control (80 to 179 mg/dL). Outcomes included rates of favorable 90-day outcome (modified Rankin Scale score ≤2) and death. RESULTS This analysis included 146 patients (74 in the intensive treatment group and 72 in the standard treatment group). Intensive blood glucose was not associated with higher rates of 90-day favorable outcomes (intensive 31.1% vs. standard 30.6%, P=1.0; odds ratio 1.025, 95% confidence interval 0.51 to 2.07) or a decrease in rates of death (intensive 20.3% vs. standard 22.2%, P=0.84; odds ratio 0.98, 95% confidence interval 0.40 to 1.97). CONCLUSIONS Intensive blood glucose control among AIS patients presenting with hyperglycemia and treated with MT was not associated with lower rates of death or higher rates of long-term favorable outcomes when compared with standard treatment.
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35
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Venema E, Roozenbeek B, Mulder MJHL, Brown S, Majoie CBLM, Steyerberg EW, Demchuk AM, Muir KW, Dávalos A, Mitchell PJ, Bracard S, Berkhemer OA, Lycklama À Nijeholt GJ, van Oostenbrugge RJ, Roos YBWEM, van Zwam WH, van der Lugt A, Hill MD, White P, Campbell BCV, Guillemin F, Saver JL, Jovin TG, Goyal M, Dippel DWJ, Lingsma HF. Prediction of Outcome and Endovascular Treatment Benefit: Validation and Update of the MR PREDICTS Decision Tool. Stroke 2021; 52:2764-2772. [PMID: 34266308 PMCID: PMC8378416 DOI: 10.1161/strokeaha.120.032935] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Supplemental Digital Content is available in the text. Background and Purpose: Benefit of early endovascular treatment (EVT) for ischemic stroke varies considerably among patients. The MR PREDICTS decision tool, derived from MR CLEAN (Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands), predicts outcome and treatment benefit based on baseline characteristics. Our aim was to externally validate and update MR PREDICTS with data from international trials and daily clinical practice. Methods: We used individual patient data from 6 randomized controlled trials within the HERMES (Highly Effective Reperfusion Evaluated in Multiple Endovascular Stroke Trials) collaboration to validate the original model. Then, we updated the model and performed a second validation with data from the observational MR CLEAN Registry. Primary outcome was functional independence (defined as modified Rankin Scale score 0–2) 3 months after stroke. Treatment benefit was defined as the difference between the probability of functional independence with and without EVT. Discriminative performance was evaluated using a concordance (C) statistic. Results: We included 1242 patients from HERMES (633 assigned to EVT, 609 assigned to control) and 3156 patients from the MR CLEAN Registry (all of whom underwent EVT within 6.5 hours). The C-statistic for functional independence was 0.74 (95% CI, 0.72–0.77) in HERMES and, after model updating, 0.80 (0.78–0.82) in the Registry. Median predicted treatment benefit of routinely treated patients (Registry) was 10.3% (interquartile range, 5.8%–14.4%). Patients with low (<1%) predicted treatment benefit (n=135/3156 [4.3%]) had low rates of functional independence, irrespective of reperfusion status, suggesting potential absence of treatment benefit. The updated model was made available online for clinicians and researchers at www.mrpredicts.com. Conclusions: Because of the substantial treatment effect and small potential harm of EVT, most patients arriving within 6 hours at an endovascular-capable center should be treated regardless of their clinical characteristics. MR PREDICTS can be used to support clinical judgement when there is uncertainty about the treatment indication, when resources are limited, or before a patient is to be transferred to an endovascular-capable center.
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Affiliation(s)
- Esmee Venema
- Department of Public Health (E.V., E.W.S., H.F.L.), Erasmus MC, University Medical Center Rotterdam, the Netherlands.,Department of Neurology (E.V., B.R., M.J.H.L.M., O.A.B., D.W.J.D.), Erasmus MC, University Medical Center Rotterdam, the Netherlands
| | - Bob Roozenbeek
- Department of Neurology (E.V., B.R., M.J.H.L.M., O.A.B., D.W.J.D.), Erasmus MC, University Medical Center Rotterdam, the Netherlands.,Department of Radiology and Nuclear Medicine (B.R., M.J.H.L.M., O.A.B., A.v.d.L.), Erasmus MC, University Medical Center Rotterdam, the Netherlands
| | - Maxim J H L Mulder
- Department of Neurology (E.V., B.R., M.J.H.L.M., O.A.B., D.W.J.D.), Erasmus MC, University Medical Center Rotterdam, the Netherlands.,Department of Radiology and Nuclear Medicine (B.R., M.J.H.L.M., O.A.B., A.v.d.L.), Erasmus MC, University Medical Center Rotterdam, the Netherlands
| | - Scott Brown
- Altair Biostatistics, St Louis Park, MN (S.B.).,Department of Diagnostic and Interventional Neuroradiology (S.B.), University of Lorraine and University Hospital of Nancy, France
| | - Charles B L M Majoie
- Department of Radiology and Nuclear Medicine (C.B.L.M.M., O.A.B.), Amsterdam University Medical Centers, location AMC, the Netherlands
| | - Ewout W Steyerberg
- Department of Public Health (E.V., E.W.S., H.F.L.), Erasmus MC, University Medical Center Rotterdam, the Netherlands.,Department of Biomedical Data Sciences, Leiden University Medical Center, the Netherlands (E.W.S.)
| | - Andrew M Demchuk
- Departments of Clinical Neuroscience and Radiology, Hotchkiss Brain Institute, Cummings School of Medicine, University of Calgary, Canada (A.M.D., MD.H., M.G.)
| | - Keith W Muir
- Institute of Neuroscience and Psychology, University of Glasgow, Queen Elizabeth University Hospital, United Kingdom (K.W.M.)
| | - Antoni Dávalos
- Department of Neuroscience, Hospital Germans Trias y Pujol, Barcelona, Spain (A.D.)
| | - Peter J Mitchell
- Department of Radiology (P.J.M.), Royal Melbourne Hospital, University of Melbourne, Parkville, Australia
| | | | - Olvert A Berkhemer
- Department of Neurology (E.V., B.R., M.J.H.L.M., O.A.B., D.W.J.D.), Erasmus MC, University Medical Center Rotterdam, the Netherlands.,Department of Radiology and Nuclear Medicine (B.R., M.J.H.L.M., O.A.B., A.v.d.L.), Erasmus MC, University Medical Center Rotterdam, the Netherlands.,Department of Radiology and Nuclear Medicine (C.B.L.M.M., O.A.B.), Amsterdam University Medical Centers, location AMC, the Netherlands
| | | | - Robert J van Oostenbrugge
- Department of Neurology (R.J.v.O.), Maastricht University Medical Center and Cardiovascular Research Institute Maastricht (CARIM), the Netherlands
| | - Yvo B W E M Roos
- Department of Neurology (Y.B.W.E.M.R.), Amsterdam University Medical Centers, location AMC, the Netherlands
| | - Wim H van Zwam
- Department of Radiology (W.H.v.Z.), Maastricht University Medical Center and Cardiovascular Research Institute Maastricht (CARIM), the Netherlands
| | - Aad van der Lugt
- Department of Radiology and Nuclear Medicine (B.R., M.J.H.L.M., O.A.B., A.v.d.L.), Erasmus MC, University Medical Center Rotterdam, the Netherlands
| | - Michael D Hill
- Departments of Clinical Neuroscience and Radiology, Hotchkiss Brain Institute, Cummings School of Medicine, University of Calgary, Canada (A.M.D., MD.H., M.G.)
| | - Philip White
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, United Kingdom (P.W.)
| | - Bruce C V Campbell
- Department of Medicine and Neurology, Melbourne Brain Center (B.C.V.C.), Royal Melbourne Hospital, University of Melbourne, Parkville, Australia
| | - Francis Guillemin
- Department of Clinical Epidemiology (F.G.), University of Lorraine and University Hospital of Nancy, France
| | - Jeffrey L Saver
- Department of Neurology and Comprehensive Stroke Center, David Geffen School of Medicine, University of Los Angeles, CA (J.L.S.)
| | - Tudor G Jovin
- Department of Neurology, Stroke Institute, University of Pittsburgh Medical Center Stroke Institute, Presbyterian University Hospital, PA (T.G.J.)
| | - Mayank Goyal
- Departments of Clinical Neuroscience and Radiology, Hotchkiss Brain Institute, Cummings School of Medicine, University of Calgary, Canada (A.M.D., MD.H., M.G.)
| | - Diederik W J Dippel
- Department of Neurology (E.V., B.R., M.J.H.L.M., O.A.B., D.W.J.D.), Erasmus MC, University Medical Center Rotterdam, the Netherlands
| | - Hester F Lingsma
- Department of Public Health (E.V., E.W.S., H.F.L.), Erasmus MC, University Medical Center Rotterdam, the Netherlands
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Psychogios K, Safouris A, Kargiotis O, Magoufis G, Andrikopoulou A, Papageorgiou E, Chondrogianni M, Papadimitropoulos G, Polyzogopoulou E, Spiliopoulos S, Brountzos E, Stamboulis E, Giannopoulos S, Tsivgoulis G. Advanced Neuroimaging Preceding Intravenous Thrombolysis in Acute Ischemic Stroke Patients Is Safe and Effective. J Clin Med 2021; 10:jcm10132819. [PMID: 34206790 PMCID: PMC8268827 DOI: 10.3390/jcm10132819] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 06/24/2021] [Accepted: 06/24/2021] [Indexed: 02/05/2023] Open
Abstract
Advanced neuroimaging is one of the most important means that we have in the attempt to overcome time constraints and expand the use of intravenous thrombolysis (IVT). We assessed whether, and how, the prior use of advanced neuroimaging (AN), and more specifically CT/MR perfusion post-processed with RAPID software, regardless of time from symptoms onset, affected the outcomes of acute ischemic stroke (AIS) patients who received IVT. Methods. We retrospectively evaluated consecutive AIS patients who received intravenous thrombolysis monotherapy (without endovascular reperfusion) during a six-year period. The study population was divided into two groups according to the neuroimaging protocol used prior to IVT administration in AIS patients (AN+ vs. AN-). Safety outcomes included any intracranial hemorrhage (ICH) and 3-month mortality. Effectiveness outcomes included door-to-needle time, neurological status (NIHSS-score) on discharge, and functional status at three months assessed by the modified Rankin Scale (mRS). Results. The rate of IVT monotherapy increased from ten patients per year (n = 29) in the AN- to fifteen patients per year (n = 47) in the AN+ group. Although the onset-to-treatment time was longer in the AN+ cohort, the two groups did not differ in door-to-needle time, discharge NIHSS-score, symptomatic ICH, any ICH, 3-month favorable functional outcome (mRS-scores of 0-1), 3-month functional independence (mRS-scores of 0-2), distribution of 3-month mRS-scores, or 3-month mortality. Conclusion. Our pilot observational study showed that the incorporation of advanced neuroimaging in the acute stroke chain pathway in AIS patients increases the yield of IVT administration without affecting the effectiveness and safety of the treatment.
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Affiliation(s)
- Klearchos Psychogios
- Acute Stroke Unit, Metropolitan Hospital, Ethnarhou Makariou 9, 18547 Piraeus, Greece; (A.S.); (O.K.); (G.M.); (A.A.); (E.P.); (M.C.); (G.P.); (E.S.)
- Second Department of Neurology, National & Kapodistrian University of Athens, School of Medicine, “Attikon” University Hospital, 12462 Athens, Greece; (S.G.); (G.T.)
- Correspondence: ; Tel.: +30-(210)480-9788 or +30-(697)340-7804
| | - Apostolos Safouris
- Acute Stroke Unit, Metropolitan Hospital, Ethnarhou Makariou 9, 18547 Piraeus, Greece; (A.S.); (O.K.); (G.M.); (A.A.); (E.P.); (M.C.); (G.P.); (E.S.)
- Second Department of Neurology, National & Kapodistrian University of Athens, School of Medicine, “Attikon” University Hospital, 12462 Athens, Greece; (S.G.); (G.T.)
| | - Odysseas Kargiotis
- Acute Stroke Unit, Metropolitan Hospital, Ethnarhou Makariou 9, 18547 Piraeus, Greece; (A.S.); (O.K.); (G.M.); (A.A.); (E.P.); (M.C.); (G.P.); (E.S.)
| | - Georgios Magoufis
- Acute Stroke Unit, Metropolitan Hospital, Ethnarhou Makariou 9, 18547 Piraeus, Greece; (A.S.); (O.K.); (G.M.); (A.A.); (E.P.); (M.C.); (G.P.); (E.S.)
| | - Athina Andrikopoulou
- Acute Stroke Unit, Metropolitan Hospital, Ethnarhou Makariou 9, 18547 Piraeus, Greece; (A.S.); (O.K.); (G.M.); (A.A.); (E.P.); (M.C.); (G.P.); (E.S.)
| | - Ermioni Papageorgiou
- Acute Stroke Unit, Metropolitan Hospital, Ethnarhou Makariou 9, 18547 Piraeus, Greece; (A.S.); (O.K.); (G.M.); (A.A.); (E.P.); (M.C.); (G.P.); (E.S.)
| | - Maria Chondrogianni
- Acute Stroke Unit, Metropolitan Hospital, Ethnarhou Makariou 9, 18547 Piraeus, Greece; (A.S.); (O.K.); (G.M.); (A.A.); (E.P.); (M.C.); (G.P.); (E.S.)
- Second Department of Neurology, National & Kapodistrian University of Athens, School of Medicine, “Attikon” University Hospital, 12462 Athens, Greece; (S.G.); (G.T.)
| | - Georgios Papadimitropoulos
- Acute Stroke Unit, Metropolitan Hospital, Ethnarhou Makariou 9, 18547 Piraeus, Greece; (A.S.); (O.K.); (G.M.); (A.A.); (E.P.); (M.C.); (G.P.); (E.S.)
| | - Eftihia Polyzogopoulou
- Emergency Medicine Clinic, National & Kapodistrian University of Athens, School of Medicine, “Attikon” University Hospital, 12462 Athens, Greece;
| | - Stavros Spiliopoulos
- Second Department of Radiology, Interventional Radiology Unit, “ATTIKON” University General Hospital, 12462 Athens, Greece; (S.S.); (E.B.)
| | - Elias Brountzos
- Second Department of Radiology, Interventional Radiology Unit, “ATTIKON” University General Hospital, 12462 Athens, Greece; (S.S.); (E.B.)
| | - Elefterios Stamboulis
- Acute Stroke Unit, Metropolitan Hospital, Ethnarhou Makariou 9, 18547 Piraeus, Greece; (A.S.); (O.K.); (G.M.); (A.A.); (E.P.); (M.C.); (G.P.); (E.S.)
| | - Sotirios Giannopoulos
- Second Department of Neurology, National & Kapodistrian University of Athens, School of Medicine, “Attikon” University Hospital, 12462 Athens, Greece; (S.G.); (G.T.)
| | - Georgios Tsivgoulis
- Second Department of Neurology, National & Kapodistrian University of Athens, School of Medicine, “Attikon” University Hospital, 12462 Athens, Greece; (S.G.); (G.T.)
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Shi Z, Guo S, Pan J, Xu C, Geng Y, Zheng S. Increased Postoperative Fasting Glucose Is Associated With Unfavorable Outcomes in Patients Treated With Mechanical Thrombectomy Treatment. Front Neurol 2021; 12:668363. [PMID: 34122311 PMCID: PMC8193515 DOI: 10.3389/fneur.2021.668363] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 05/10/2021] [Indexed: 01/01/2023] Open
Abstract
Background and objective: Hyperglycemia on admission was associated with worse clinical outcomes after mechanical thrombectomy (MT) of acute ischemic stroke (AIS). We evaluated whether increased postoperative fasting glucose (PFG) was also related to poor clinical outcomes in patients who underwent MT treatment. Methods: Consecutive patients with large vessel occlusion underwent MT in our center were included. Admission glucose and fasting glucose levels after MT treatment were evaluated. Primary outcome was 90-day unfavorable outcomes (modified Rankin Scale score of 3–6). Secondary outcome was the rate of symptomatic intracranial hemorrhage (sICH) after MT treatment. The association of PFG and 90-day clinical outcome after MT treatment was determined using logistic regression analyses. Results: One hundred twenty seven patients were collected. The median postoperative fasting glucose level was 6.27 mmol/L (IQR 5.59–7.62). Fourteen patients (11.02%) had sICH, and fifty-eight patients (45.67%) had unfavorable outcomes at 90-day after MT. After adjustment for potential confounding factors, PFG level was an independent predictor of 90-day unfavorable outcome (OR 1.265; 95% CI 1.017–1.575; p = 0.035) and sICH (OR 1.523; 95% CI 1.056–2.195; p = 0.024) after MT. In addition, older age, higher baseline NIHSS score, and higher postoperative NLR were also associated with unfavorable outcomes at 90-day after MT treatment. Conclusions: Increased PFG is associated with unfavorable outcomes at 90-day and an increased risk of sICH in patients underwent MT treatment.
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Affiliation(s)
- Zongjie Shi
- Zhejiang Provincial People's Hospital, Hangzhou, China.,Hangzhou Medical College, Hangzhou, China
| | - Shunyuan Guo
- Zhejiang Provincial People's Hospital, Hangzhou, China.,Hangzhou Medical College, Hangzhou, China
| | - Jie Pan
- Zhejiang Provincial People's Hospital, Hangzhou, China.,Hangzhou Medical College, Hangzhou, China
| | - Chao Xu
- Zhejiang Provincial People's Hospital, Hangzhou, China.,Hangzhou Medical College, Hangzhou, China
| | - Yu Geng
- Zhejiang Provincial People's Hospital, Hangzhou, China.,Hangzhou Medical College, Hangzhou, China
| | - Sujie Zheng
- Zhejiang Provincial People's Hospital, Hangzhou, China.,Hangzhou Medical College, Hangzhou, China
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38
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Guenego A, Lucas L, Gory B, Richard S, Aubertin M, Weisenburger-Lile D, Labreuche J, Dargazanli C, Benali A, Bourcier R, Detraz L, Vannier S, Guillen M, Eugene F, Walker G, Lun R, Wormsbecker A, Ducroux C, Piotin M, Blanc R, Consoli A, Lapergue B, Fahed R. Thrombectomy for Comatose Patients with Basilar Artery Occlusion : A Multicenter Study. Clin Neuroradiol 2021; 31:1131-1140. [PMID: 33704508 DOI: 10.1007/s00062-021-01001-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 02/04/2021] [Indexed: 12/27/2022]
Abstract
PURPOSE Acute ischemic stroke (AIS) secondary to a basilar artery occlusion (BAO) carries a poor prognosis, especially in cases of severe symptoms, such as coma at presentation. Despite a lack of evidence, mechanical thrombectomy (MT) is often performed as the procedural risks are felt to be minimal compared to the natural history. We sought to evaluate MT efficacy and safety in comatose BAO patients. METHODS We performed a retrospective analysis of a multicenter prospective cohort of consecutive AIS patients with BAO who underwent MT. We compared baseline characteristics between comatose and noncomatose BAO patients, as well as clinical outcomes (modified Rankin scale, mRS 0-3 at 3 months). Using a multivariate logistic regression, we examined the population of comatose patients for baseline predictive factors of mortality. RESULTS We included 269 patients, 72 (27%) comatose and 197 (73%) non-comatose. Despite similar recanalization rates between comatose and non-comatose patients (83% vs. 90% p = 0.221), comatose patient long-term outcomes were dramatically worse (11% mRS 0-3 vs. 54%, p < 0.0001) and mortality was higher (64% vs. 34%, p < 0.0001). Baseline predictors of mortality at 3 months among comatose BAO patients after multivariate analysis were the following: male sex (odds ratio, OR 31.20, 2.57-378.52, p = 0.007), older age (OR 1.13, 1.04-1.24, p = 0.007) and higher serum glucose levels (OR 1.54, 1.07-2.21, p = 0.019). CONCLUSION Thrombectomy is technically effective for BAO patients presenting with coma; however, the long-term favorable outcome remains poor. Male sex, old age and hyperglycemia were predictors of mortality in these patients.
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Affiliation(s)
- Adrien Guenego
- Interventional Neuroradiology Department, Foundation Rothschild Hospital, Paris, France.,Department of Interventional Neuroradiology, Erasme University Hospital, Brussels, Belgium
| | - Ludovic Lucas
- Neurovascular Unit, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Benjamin Gory
- Department of Diagnostic, Université de Lorraine, CHRU-Nancy, 54000, Nancy, France.,Therapeutic Neuroradiology, Université de Lorraine, IADI, INSERM U1254, 54000, Nancy, France.,INSERM U1116, CHRU-Nancy, 54000, Nancy, France
| | - Sébastien Richard
- INSERM U1116, CHRU-Nancy, 54000, Nancy, France.,Department of Neurology, Stroke Unit, Université de Lorraine, CHRU-Nancy, 54000, Nancy, France
| | - Mathilde Aubertin
- Interventional Neuroradiology Department, Foundation Rothschild Hospital, Paris, France
| | | | - Julien Labreuche
- ULR 2694-METRICS: évaluation des technologies de santé et des pratiques médicales, Univ. Lille, CHU Lille, 59000, Lille, France
| | - Cyril Dargazanli
- Department of Neuroradiology, Centre Hospitalier Universitaire Gui de Chauliac, Montpellier, France
| | - Amel Benali
- Department of Neuroradiology, Centre Hospitalier Universitaire Gui de Chauliac, Montpellier, France
| | - Romain Bourcier
- Department of Diagnostic and Therapeutic Neuroradiology, University Hospital of Nantes, L'institut du thorax, Inserm 1087, CNRS, UNIV Nantes, Nantes, France
| | - Lili Detraz
- Department of Diagnostic and Therapeutic Neuroradiology, University Hospital of Nantes, L'institut du thorax, Inserm 1087, CNRS, UNIV Nantes, Nantes, France
| | - Stéphane Vannier
- Neurovascular Unit, Centre Hospitalier Universitaire Pontchaillou, Rennes, France
| | - Maud Guillen
- Neurovascular Unit, Centre Hospitalier Universitaire Pontchaillou, Rennes, France
| | - François Eugene
- Department of Neuroradiology, Centre Hospitalier Universitaire Pontchaillou, Rennes, France
| | - Gregory Walker
- Department of Medicine - Division of Neurology, The Ottawa Hospital, Ottawa Hospital Research Institute and University of Ottawa-Civic Campus, 1053 Carling Avenue, K1Y4E9, Ottawa, ON, Canada.,Department of Medicine-Division of Neurology; Royal Columbian Hospital, New Westminster, University of British Columbia, British Columbia, Canada
| | - Ronda Lun
- Department of Medicine - Division of Neurology, The Ottawa Hospital, Ottawa Hospital Research Institute and University of Ottawa-Civic Campus, 1053 Carling Avenue, K1Y4E9, Ottawa, ON, Canada
| | - Andrew Wormsbecker
- Department of Critical Care and Internal Medicine; Royal Columbian Hospital, New Westminster, University of British Columbia, British Columbia, Canada
| | - Célina Ducroux
- Interventional Neuroradiology Department, Foundation Rothschild Hospital, Paris, France
| | - Michel Piotin
- Interventional Neuroradiology Department, Foundation Rothschild Hospital, Paris, France
| | - Raphael Blanc
- Interventional Neuroradiology Department, Foundation Rothschild Hospital, Paris, France
| | - Arturo Consoli
- Department of Neuroradiology, Foch Hospital, Suresnes, France
| | | | - Robert Fahed
- Interventional Neuroradiology Department, Foundation Rothschild Hospital, Paris, France. .,Department of Medicine - Division of Neurology, The Ottawa Hospital, Ottawa Hospital Research Institute and University of Ottawa-Civic Campus, 1053 Carling Avenue, K1Y4E9, Ottawa, ON, Canada.
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Li X, Li C, Shi M, Qu Y, Huo L, Hao Z, Yue F, Gan L, Wang S. Which Glucose Parameter Best Predicts Poor Outcome after Mechanical Thrombectomy for Acute Large Vessel Occlusion Stroke? Intern Med J 2021; 52:1374-1380. [PMID: 33665935 DOI: 10.1111/imj.15259] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 01/18/2021] [Accepted: 02/20/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Hyperglycemia is related to adverse outcomes in patients with acute ischemic stroke treated by mechanical thrombectomy (MT). AIM To compare the predictive ability of admission blood glucose (ABG), fasting blood glucose (FBG), and glycated hemoglobin (HbA1c) in patients with acute large vessel occlusion (ALVO) stroke undergoing MT. METHODS The study retrospectively analyzed the data of 329 consecutive acute stroke patients treated by MT. Multivariate logistic regression analysis was performed to investigate the predictors of poor functional outcome. Receiver operating characteristic (ROC) analysis was performed to identify the predictive ability of ABG, FBG, and HbA1c for poor functional independence in patients with ALVO stroke undergoing MT. In addition, subgroup analyses were performed for both diabetic and nondiabetic patients. RESULTS Multiple logistic regression analysis demonstrated that ABG and FBG were independent predictors of 3-month poor functional outcome; however, HbA1c could not predict poor functional outcome. Receiver operating characteristic (ROC) analysis showed that FBG has a higher predictive ability than ABG (areas under the ROC curve [AUCs]: 0.689 vs. 0.624, P = 0.037) and HbA1c (AUCs: 0.689 vs. 0.541, P<0.001) for poor function outcome. CONCLUSIONS ABG and FBG are independent predictors of poor functional outcome in patients with acute ischemic stroke undergoing MT, and FBG has a higher predictive ability than ABG and HbA1c. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Xiandong Li
- Department of Neurology and Neuroscience, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Chao Li
- Department of Neurology and Neuroscience, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Mingchao Shi
- Department of Neurology and Neuroscience, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Yang Qu
- Department of Neurology and Neuroscience, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Longwen Huo
- Department of Neurology and Neuroscience, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Zeyu Hao
- Department of Neurology and Neuroscience, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Feixue Yue
- Department of Neurology and Neuroscience, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Lin Gan
- Department of Neurology and Neuroscience, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Shouchun Wang
- Department of Neurology and Neuroscience, The First Hospital of Jilin University, Changchun, Jilin, China
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Zang L, Zhang D, Yao Y, Wang Y. Symptomatic intracranial hemorrhage in patients with admission hyperglycemia and diabetes after mechanical thrombectomy: A systematic review and meta-analysis. Am J Emerg Med 2021; 45:23-28. [PMID: 33647758 DOI: 10.1016/j.ajem.2021.02.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 02/16/2021] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVES Symptomatic intracranial hemorrhage (sICH) is a severe complication of revascularization therapy. We aimed to investigate the association of admission hyperglycemia and sICH after mechanical thrombectomy in patients with acute ischemic stroke. METHODS We systematically searched PubMed, EMBASE and Cochrane Library to identify studies that reported incidence of sICH in patients with admission hyperglycemia and normoglycemia, or with and without a history of diabetes, or glucose level in patients with sICH and non-sICH from inception to December 10, 2019. The estimate effects were pooled by random-effects model. RESULTS Twelve eligible studies were included with 4892 patients enrolled. The risk of sICH was significantly higher in admission hyperglycemia patients than that in normoglycemia (OR 2.93, 95% CI 1.34-6.42, p = 0.007; adjusted OR1.95, 95% CI 1.22-3.13; p = 0.006). The admission glucose level was significantly higher in sICH patients than that in non-sICH with a mean difference of 37.49 (95% CI 3.03-71.94, p = 0.03). The risk of sICH increased with elevating glucose level (adjusted OR 1.06, 95% CI 1.01-1.11; p = 0.02). The risk of sICH was not significantly increased in patients with a history of diabetes than that of those without (OR 1.74, 95% CI 1.00-3.03, p = 0.05; adjusted OR 2.26, 95% CI 0.97-5.28; p = 0.06). CONCLUSIONS In patients of acute ischemic stroke treated with mechanical thrombectomy, the risk of sICH was associated with admission hyperglycemia but possibly not with a history of diabetes.
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Affiliation(s)
- Lin Zang
- Department of Neurology, People's Hospital of Liaoning Province, 33 Wenyi Road, Shenhe District, Shenyang 110016, People's Republic of China; Dalian Medical University, 9 Western Sections, Lvshun South Street, Lvshunkou District, Dalian 116044, People's Republic of China
| | - Dan Zhang
- Department of Neurology, People's Hospital of Liaoning Province, 33 Wenyi Road, Shenhe District, Shenyang 110016, People's Republic of China; Dalian Medical University, 9 Western Sections, Lvshun South Street, Lvshunkou District, Dalian 116044, People's Republic of China
| | - Yanyan Yao
- Department of Neurology, People's Hospital of Liaoning Province, 33 Wenyi Road, Shenhe District, Shenyang 110016, People's Republic of China; China Medical University, 77 Puhe Road, Shenyang North New Area, Shenyang 110122, People's Republic of China
| | - Yujie Wang
- Department of Neurology, People's Hospital of Liaoning Province, 33 Wenyi Road, Shenhe District, Shenyang 110016, People's Republic of China; China Medical University, 77 Puhe Road, Shenyang North New Area, Shenyang 110122, People's Republic of China.
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Weyland CS, Mokli Y, Vey JA, Kieser M, Herweh C, Schönenberger S, Bendszus M, Möhlenbruch MA, Ringleb PA, Nagel S. Predictors for Failure of Early Neurological Improvement After Successful Thrombectomy in the Anterior Circulation. Stroke 2021; 52:1291-1298. [PMID: 33626903 DOI: 10.1161/strokeaha.120.030519] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND PURPOSE Failure of early neurological improvement (fENI) despite successful mechanical thrombectomy in the anterior circulation is a clinically frequent occurrence. Purpose of this analysis was to define independent clinical, radiological, laboratory, or procedural predictors for fENI. METHODS Retrospective single-center analysis of patients treated for acute ischemic stroke in the anterior circulation ensuing successful mechanical thrombectomy between January 2014 and April 2019. Patients were compared according to fENI (equal or higher National Institutes of Health Stroke Scale) and ENI (lower National Institutes of Health Stroke Scale at discharge). Thirty-eight variables were examined in multivariable analysis for association with fENI. RESULTS Five hundred forty-nine out of 1146 patients experienced successful recanalization (modified Treatment in Cerebral Ischemia 2c-3). fENI occurred in 115/549 (20.9%) patients. Independent predictors of fENI were premorbid modified Rankin Scale (odds ratio [OR] per point [IC], 1.21 [1.00-1.46], P=0.049), end-stage renal failure (OR [IC], 12.18 [2.01-73.63], P=0.007), admission glucose (OR [IC], 1.018 [1.004-1.013] per mg/dL, P=0.001), bridging IV lysis (OR [IC], 0.57 [0.35-0.93], P: 0.024), time from groin puncture to final recanalization (OR [IC], 1.004 [1.001-1.007] per minute, P=0.015), general anesthesia during mechanical thrombectomy (OR, 2.41 [1.43-4.08], P<0.001), symptomatic intracranial hemorrhage (OR [CI], 6.81 [1.84-25.16], P=0.004), and follow-up Alberta Stroke Program Early CT Score (OR [IC], 0.76 [0.69-0.84] per point, P<0.001). In a secondary analysis, involvement of the regions internal capsule, M4 and M5 (motor cortex) were further independent predictors for fENI. Patients with ENI were more likely to experience a good outcome (modified Rankin Scale on day 90, 0-2: n=229/435 [52.8%] versus n=13/115 [11.3%]; P<0.001). CONCLUSIONS The extent of infarction and the involvement of motor cortex and internal capsule as well as higher premorbid modified Rankin Scale, end-stage renal failure, high glucose level on admission, absence of bridging IV lysis, general anesthesia, and a longer therapy interval are presumably independent predictors for fENI in patients with successful mechanical thrombectomy.
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Affiliation(s)
- Charlotte S Weyland
- Department of Neuroradiology (C.S.W., C.H., M.A.M.), Heidelberg University Hospital, Germany
| | - Yahia Mokli
- Department of Neurology (Y.M., S.S., P.A.R.), Heidelberg University Hospital, Germany
| | - Johannes A Vey
- Institute of Medical Biometry and Informatics (J.A.V., M.K.), Heidelberg University Hospital, Germany
| | - Meinhard Kieser
- Institute of Medical Biometry and Informatics (J.A.V., M.K.), Heidelberg University Hospital, Germany
| | - Christian Herweh
- Department of Neuroradiology (C.S.W., C.H., M.A.M.), Heidelberg University Hospital, Germany
| | - Silvia Schönenberger
- Department of Neurology (Y.M., S.S., P.A.R.), Heidelberg University Hospital, Germany
| | | | - Markus A Möhlenbruch
- Department of Neuroradiology (C.S.W., C.H., M.A.M.), Heidelberg University Hospital, Germany
| | - Peter A Ringleb
- Department of Neurology (Y.M., S.S., P.A.R.), Heidelberg University Hospital, Germany
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Zhang YH, Shi MC, Wang ZX, Li C, Sun MY, Zhou J, Zhang WB, Huo LW, Wang SC. Factors Associated with Poor Outcomes in Patients Undergoing Endovascular Therapy for Acute Ischemic Stroke due to Large-Vessel Occlusion in Acute Anterior Circulation: A Retrospective Study. World Neurosurg 2021; 149:e128-e134. [PMID: 33621671 DOI: 10.1016/j.wneu.2021.02.064] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Revised: 02/12/2021] [Accepted: 02/13/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To investigate factors associated with poor clinical outcomes in patients with acute ischemic stroke undergoing endovascular therapy. METHODS A retrospective review of 265 patients with acute ischemic stroke treated in the First Hospital of Jilin University between January 1, 2016, and November 1, 2019, was performed. The primary outcome was the proportion of patients with a modified Rankin score of 0-2 at 90 days. Univariate and multivariate analyses were performed to assess potential clinical factors associated with a poor 90-day outcome. RESULTS The rates of successful revascularization, good prognosis, symptomatic intracranial hemorrhage, and mortality were 84.5%, 46.0%, 9.8%, and 12.8%, respectively. As per univariate analysis, age, diagnosis of atrial fibrillation, diagnosis of diabetes, high baseline glucose level, tandem occlusion, high National Institutes of Health Stroke Scale (NIHSS) score at admission, general anesthesia, number of passes, high NIHSS score on discharge, unsuccessful recanalization (modified treatment in cerebral ischemia score <2b), and development of symptomatic intracranial hemorrhage, hemorrhagic infarction, parenchymal hematoma, and subarachnoid hemorrhage were associated with poor prognosis. Tobacco use was positive in correlation with good prognosis in univariate analysis. Diabetes, tandem occlusion, high NIHSS score at admission, and general anesthesia were independent factors associated with a poor 90-day outcome in multivariate analysis. CONCLUSIONS Diabetes, tandem occlusion, high NIHSS score at admission, and general anesthesia were independent risk factors associated with a poor 90-day outcome and should be considered a reference by neurointerventionalists in guiding their clinical decision-making.
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Affiliation(s)
- Yi-He Zhang
- Department of Neurology The First Hospital of Jilin University, Changchun, China
| | - Ming-Chao Shi
- Department of Neurology The First Hospital of Jilin University, Changchun, China
| | - Zhong-Xiu Wang
- Department of Neurology The First Hospital of Jilin University, Changchun, China
| | - Chao Li
- Department of Neurology The First Hospital of Jilin University, Changchun, China
| | - Meng-Yao Sun
- Department of Ultrasound, The First Hospital of Jilin University, Changchun, China
| | - Jie Zhou
- Department of Neurology The First Hospital of Jilin University, Changchun, China
| | - Wen-Bin Zhang
- Department of Neurology The First Hospital of Jilin University, Changchun, China
| | - Long-Wen Huo
- Department of Neurology The First Hospital of Jilin University, Changchun, China
| | - Shou-Chun Wang
- Department of Neurology The First Hospital of Jilin University, Changchun, China.
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Kim TJ, Lee JS, Park SH, Ko SB. Short-term glycemic variability and hemorrhagic transformation after successful endovascular thrombectomy. Transl Stroke Res 2021; 12:968-975. [PMID: 33576937 DOI: 10.1007/s12975-021-00895-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 01/09/2021] [Accepted: 02/02/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND Glycemic variability (GV) is a risk factor for poor outcomes after ischemic stroke. However, its effect on hemorrhagic transformation after endovascular recanalization therapy (ERT) remains to be elucidated. METHODS Patients with acute ischemic stroke due to large vessel occlusion with successful recanalization after ERT (modified thrombolysis in cerebral infarction 2b or 3) were enrolled between January 2013 and November 2019. Blood glucose level data were obtained during the first 36 h after ERT, and ten GV parameters including time rate (TR) of glucose variation were assessed. The TR of glucose variation reflects the speed of glucose fluctuations over time (mg/dL/hour) during the monitoring period. Symptomatic intracerebral hemorrhage (sICH) and unfavorable outcomes at 3 months after ERT were analyzed. The sICH was defined as parenchymal hematoma type 2 with a neurological deterioration of 4 points or more on the National Institute of Health Stroke Scale. Moreover, a modified Rankin Scale of 3-6 at 3 months was considered an unfavorable outcome. RESULTS Among all patients (n = 176; mean age, 69.3 years; 47.7 % female), sICH developed after successful ERT in 16 (9.1%) patients. In addition, 54% (n = 95) patients had an unfavorable outcome at 3 months. Patients with sICH and unfavorable outcome had higher the TR of glucose variation. After adjusting for potential confounders, the TR of glucose (per 1 mg/dL/h increase) variation was independently associated with sICH (odds ratio, 1.17; 95% confidence interval [CI], 1.012-1.343) and 3-month unfavorable outcome (OR 1.14, 95% CI, 1.000-1.297). CONCLUSIONS Time-related GV during the first 36 h after successful ERT has a stronger correlation with sICH and poor functional outcomes compared to any GV parameters. This suggests that maintaining stable glucose may be an important factor in the prevention of sICH after undergoing successful ERT.
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Affiliation(s)
- Tae Jung Kim
- Department of Neurology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
- Department of Critical Care Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Ji Sung Lee
- Department of Clinical Research Center, Asan Institute for Life Sciences, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Soo-Hyun Park
- Department of Neurology, Inha University Hospital, Incheon, Republic of Korea
| | - Sang-Bae Ko
- Department of Neurology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.
- Department of Critical Care Medicine, Seoul National University Hospital, Seoul, Republic of Korea.
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Psychogios K, Palaiodimou L, Katsanos AH, Magoufis G, Safouris A, Kargiotis O, Spiliopoulos S, Papageorgiou E, Theodorou A, Voumvourakis K, Broutzos E, Stamboulis E, Tsivgoulis G. Real-world comparative safety and efficacy of tenecteplase versus alteplase in acute ischemic stroke patients with large vessel occlusion. Ther Adv Neurol Disord 2021; 14:1756286420986727. [PMID: 33488774 PMCID: PMC7809628 DOI: 10.1177/1756286420986727] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 12/15/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND AND AIMS Tenecteplase has recently emerged as an alternative thrombolytic agent in acute ischemic stroke (AIS) patients with large vessel occlusion (LVO), possibly superior in achieving early reperfusion compared with alteplase. We aimed to compare the safety and efficacy of intravenous tenecteplase with intravenous alteplase for AIS patients with LVO in everyday clinical practice settings. METHODS We prospectively evaluated patients with AIS due to LVO, treated with intravenous thrombolysis (IVT) with or without mechanical thrombectomy in two tertiary stroke centers. Patients were treated with standard-dose alteplase (0.9 mg/kg) or 0.25 mg/kg tenecteplase. Safety outcomes included prevalence of symptomatic intracranial hemorrhage (sICH) and mortality. Efficacy outcomes included averted thrombectomy, major neurological improvement at 24 h (defined as decrease in baseline NIHSS score of 8 points or greater) and functional status on discharge and on 3 months assessed by modified Rankin Scale (mRS). RESULTS Nineteen AIS patients with LVO received tenecteplase and 39 received alteplase. We observed a non-significant higher rate of averted thrombectomies (32% versus 18%, p = 0.243) and a non-significant higher rate of sICH (16% versus 5%, p = 0.201) in the tenecteplase group. The rate of 24 h major neurological improvement was higher in the tenecteplase group (64% versus 33%, p = 0.046) but this was marginally attenuated in multivariable analyses (adjusted OR 10.22, 95% CI: 0.73-142.98; p = 0.084). Discharge mRS, 3-months mRS, and 3-month functional independence (mRS scores of 0-2) did not differ (p > 0.2) between the two groups. The rates of 3-month mortality (11% versus 18%, p = 0.703) were similar in the two groups. No independent association between thrombolytic agent and safety or efficacy outcomes emerged in multivariable regression analyses. CONCLUSION The present pilot observational study highlights that AIS patients with LVO treated with 0.25 mg/kg bolus administration of tenecteplase had increased likelihood to achieve early neurological improvement compared with AIS patients treated with alteplase, but this association was attenuated after adjustment for potential confounders. There were no significant differences in 3-month functional or safety outcomes between the two groups. This preliminary real-world observation requires independent confirmation in larger, multicenter studies.
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Affiliation(s)
- Klearchos Psychogios
- Acute Stroke Unit, Metropolitan Hospital, Ethnarhou Makariou 9, Athens, Piraeus 18547, Greece
- Second Department of Neurology, Attikon University Hospital, School of Medicine, University of Athens, Athens, Greece
| | - Lina Palaiodimou
- Second Department of Neurology, Attikon University Hospital, School of Medicine, University of Athens, Athens, Greece
| | - Aristeidis H. Katsanos
- Division of Neurology, McMaster University/Population Health Research Institute, Hamilton, Canada
| | - Georgios Magoufis
- Department of Interventional Neuroradiology, Metropolitan Hospital, Piraeus, Greece
| | | | | | - Stavros Spiliopoulos
- Second Department of Radiology, Division of Interventional Radiology, School of Medicine, National and Kapodistrian University of Athens, Attikon University General Hospital, Athens, Greece
| | | | - Aikaterini Theodorou
- Second Department of Neurology, Attikon University Hospital, School of Medicine, University of Athens, Athens, Greece
| | - Konstantinos Voumvourakis
- Second Department of Neurology, Attikon University Hospital, School of Medicine, University of Athens, Athens, Greece
| | - Elias Broutzos
- Second Department of Radiology, Division of Interventional Radiology, School of Medicine, National and Kapodistrian University of Athens, Attikon University General Hospital, Athens, Greece
| | | | - Georgios Tsivgoulis
- Second Department of Neurology, Attikon University Hospital, School of Medicine, University of Athens, Athens, Greece
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Yue F, Wang Z, Pu J, Zhang M, Liu Y, Han H, Liu W, Wang X, Li R, Xue D, Cao J, Yan Z, Niu G, Zhang H, Guan H, Zeng H, You F, Yang Q, Zi W, Zhang Y, Shao Z, Liu J, Sun J, Wang S. HbA1c and clinical outcomes after endovascular treatment in patients with posterior circulation large vessel occlusion: a subgroup analysis of a nationwide registry (BASILAR). Ther Adv Neurol Disord 2020; 13:1756286420981354. [PMID: 33447263 PMCID: PMC7780201 DOI: 10.1177/1756286420981354] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Accepted: 11/24/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND AND AIMS Recently, several clinical trials have shown that increased glycated hemoglobin (HbA1c) level is correlated with poor clinical outcomes in ischemic stroke patients after thrombolysis and possibly after mechanical thrombectomy. However, the effect of HbA1c on posterior circulation large vessel occlusion (PCLVO) patients treated with endovascular thrombectomy (EVT) remains unclear. This multicenter study assessed the association between the HbA1c levels and clinical outcomes in patients with PCLVO after EVT. METHODS We studied 385 PCLVO ischemic stroke patients included in the EVT for acute basilar artery occlusion study (BASILAR). Patients were divided into a high HbA1c level group (HbA1c >6.5%) and a low HbA1c level group (HbA1c ⩽6.5%). The efficacy outcome was a 90-day favorable functional outcome (modified Rankin Scale 0-3). The safety outcomes included symptomatic intracerebral hemorrhage and mortality at 90 days after EVT. RESULTS The frequency of a favorable outcome in patients with an HbA1c ⩽6.5% was significantly higher than that in the HbA1c >6.5% group (41.2% versus 26.2%, p = 0.001). In multivariate analysis with adjusted confounders, high HbA1c levels and favorable outcomes were significantly negatively correlated. There was also a significant association between high HbA1c levels and mortality after 3 months. The negative effects of high HbA1c levels on functional status after 3 months were exacerbated in patients aged ⩾65 years. CONCLUSION Our multicenter study suggests that a higher serum HbA1c level (HbA1c >6.5%) is an independent predictor of a 90-day poor outcome and mortality in patients with PCLVO after EVT, particularly in those aged ⩾65 years.Clinical Trial Registry identifier: ChiCTR1800014759.
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Affiliation(s)
- Feixue Yue
- Department of Neurology, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Zhongxiu Wang
- Department of Neurology, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Jie Pu
- Department of Neurology, Hubei Province People’s Hospital, Wuhan, China
| | - Min Zhang
- Department of Neurology, Chinese Medical Hospital of Maoming, Maoming, China
| | - Yong Liu
- Department of Neurology, Liu’an Affiliated Hospital of Anhui Medical University, Liu’an, China
| | - Hongxing Han
- Department of Neurology, Linyi People’s Hospital, Linyi, China
| | - Wenhua Liu
- Department of Neurology, Wuhan No. 1 Hospital, Wuhan, China
| | - Xianjun Wang
- Department of Neurology, Linyi People’s Hospital, Linyi, China
| | - Rongzong Li
- Department of Neurology, The 924th Hospital of The People’s Liberation Army, Guilin, China
| | - Dongzhang Xue
- Department of Neurology, The 902th Hospital of The People’s Liberation Army, Bangfu, China
| | - Jiaming Cao
- Department of Neurology, The 904th Hospital of The People’s Liberation Army, Wuxi, China
| | - Zhizhong Yan
- Department of Neurology, The 904th Hospital of The People’s Liberation Army, Wuxi, China
| | - Guozhong Niu
- Department of Neurology, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Hao Zhang
- Department of Neurology, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Haitao Guan
- Department of Neurology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Hongliang Zeng
- Department of Neurology, Ganzhou People’s Hospital, Ganzhou, China
| | - Feng You
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Qian Yang
- Department of Neurology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Wenjie Zi
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Yi Zhang
- Department of Neurology, The First People’s Hospital of Chenzhou, Chenzhou, China
| | - Zetao Shao
- Department of Neurology, Changle People’s Hospital, Weifang, China
| | - Jincheng Liu
- Department of Neurology, The First People’s Hospital of Xiangyang, Hubei Medical University, Xiangyang, China
| | - Jun Sun
- Department of Neurology, Nanyang Central Hospital, Nanyang, China
| | - Shouchun Wang
- Department of Neurology, The First Hospital of Jilin University, No. 1 Xinmin Street, Changchun, Jilin 130021, China
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Yazawa Y, Ohira T, Itabashi R, Uchida K, Sakai N, Yamagami H, Morimoto T, Yoshimura S. Association of Admission Hyperglycemia with Clinical Outcomes in Japanese Patients with Acute Large Vessel Occlusion Stroke: A post hoc Analysis of the Recovery by Endovascular Salvage for Cerebral Ultra-Acute Embolism Japan Registry 2. Cerebrovasc Dis 2020; 50:12-19. [DOI: 10.1159/000511679] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 09/18/2020] [Indexed: 11/19/2022] Open
Abstract
<b><i>Introduction:</i></b> Admission hyperglycemia is an indicator of poor functional prognosis in acute stroke, but investigations of its prevalence and effects on the outcomes of acute large vessel occlusion in real-world, large-scale studies are limited, especially in Asian population. <b><i>Objective:</i></b> We aimed to elucidate the relationship between admission hyperglycemia and outcomes in a prospective multicenter registry in Japan. <b><i>Methods:</i></b> We analyzed data from the Recovery by Endovascular Salvage for Cerebral Ultra-Acute Embolism (RESCUE) Japan Registry 2, which was a prospective, multicenter registry that enrolled patients from 46 centers in Japan. Admission hyperglycemia was defined as blood glucose level >140 mg/dL. The relationships between clinical outcomes and admission hyperglycemia were analyzed in all 1,932 assessable patients. A favorable functional outcome, defined as a modified Rankin Scale score of 0–2 at day 90, as well as mortality within 90 days and symptomatic intracranial hemorrhage (SICH) within 72 h, was analyzed. We performed subgroup analyses of the adjusted variables to investigate the association between hyperglycemia and favorable outcome in relation to each variable. <b><i>Results:</i></b> Admission hyperglycemia was present in 687 (35.6%) of the assessable patients and in 420 (26.9%) of the 1,561 patients without diabetes. A favorable outcome was significantly less frequent in the hyperglycemia group than in the no-hyperglycemia group (33.2% vs. 47.6%, adjusted odds ratio [OR]: 0.60, 95% confidence interval [CI]: 0.47–0.76). The mortality rates were 12.8% and 6.8% in the hyperglycemia and no-hyperglycemia groups, respectively. The incidence of SICH within 72 h was higher in the hyperglycemia group than in the no-hyperglycemia group (4.4% vs. 1.9%, adjusted OR: 2.54, 95% CI: 1.36–4.82). Hyperglycemia was associated with unfavorable outcomes in almost all subgroups. <b><i>Conclusions:</i></b> Admission hyperglycemia in Japanese patients with large vessel occlusion stroke is associated with an unfavorable functional outcome at 90 days, mortality within 90 days, and the occurrence of SICH within 72 h.
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Yaghi S, Dehkharghani S, Raz E, Jayaraman M, Tanweer O, Grory BM, Henninger N, Lansberg MG, Albers GW, Havenon AD. The Effect of Hyperglycemia on Infarct Growth after Reperfusion: An Analysis of the DEFUSE 3 trial. J Stroke Cerebrovasc Dis 2020; 30:105380. [PMID: 33166769 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105380] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 09/24/2020] [Accepted: 09/29/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND AND PURPOSE Brain infarct growth, despite successful reperfusion, decreases the likelihood of good functional outcome after ischemic stroke. In patients undergoing reperfusion, admission glucose is associated with poor outcome but the effect of glucose level on infarct growth is not well studied. MATERIALS AND METHODS This is a secondary analysis of the DEFUSE 3 trial. The primary predictor was baseline glucose level and the primary outcome is the change of the ischemic core volume from the baseline to 24-hour follow-up imaging (∆core), transformed as a cube root to reduce right skew. We included DEFUSE 3 patients who were randomized to endovascular therapy, had perfusion imaging data at baseline, an MRI at 24 hours, and who achieved TICI 2b or 3. Linear regression models, both unadjusted and adjusted, were fit to the primary outcome and all models included the baseline core volume as a covariate to normalize ∆core. RESULTS We identified 62 patients who met our inclusion criteria. The mean age was 68.1±13.1 (years), 48.4% (30/62) were men, and the median (IQR) cube root of ∆core was 2.8 (2.0-3.8) mL. There was an association between baseline glucose level and normalized ∆core in unadjusted analysis (beta coefficient 0.010, p = 0.01) and after adjusting for potential confounders (beta coefficient 0.008, p = 0.03). CONCLUSION In acute ischemic stroke patients with large vessel occlusion undergoing successful endovascular reperfusion, baseline hyperglycemia is associated with infarction growth. Further study is needed to establish potential neuroprotective benefits of aggressive glycemic control prior to and after reperfusion.
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Affiliation(s)
- Shadi Yaghi
- Department of Neurology, NYU Langone Health, 150 55th St Suite 3667, Brooklyn, NY 11220, USA.
| | - Seena Dehkharghani
- Department of Radiology, NYU Langone Health, New York, NY, United States.
| | - Eytan Raz
- Department of Radiology, NYU Langone Health, New York, NY, United States.
| | - Mahesh Jayaraman
- Department of Neurology, Brown University, Providence, RI, United States; Department of Radiology, Brown University, Providence, RI, United States; Department of Neuorosurgery, Brown University, Providence, RI, United States.
| | - Omar Tanweer
- Department of Neurosurgery, NYU Langone Health, New York, NY, United States.
| | - Brian Mac Grory
- Department of Neurology, Duke University, Durham, NC, United States.
| | - Nils Henninger
- Department of Neurology, University of Massachusetts, Worcester, MA, United States; Department of Psychiatry, University of Massachusetts, Worcester, MA, United States.
| | - Maarten G Lansberg
- Department of Neurology, Stanford University, San Francisco, CA, United States.
| | - Gregory W Albers
- Department of Neurology, Stanford University, San Francisco, CA, United States.
| | - Adam de Havenon
- Department of Neurology, University of Utah Medical Center, Salt Lake City, UT, United States.
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48
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Dynamic Hyperglycemic Patterns Predict Adverse Outcomes in Patients with Acute Ischemic Stroke Undergoing Mechanical Thrombectomy. J Clin Med 2020; 9:jcm9061932. [PMID: 32575739 PMCID: PMC7355777 DOI: 10.3390/jcm9061932] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 06/18/2020] [Accepted: 06/18/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Admission hyperglycemia impairs outcome in acute ischemic stroke (AIS) patients undergoing mechanical thrombectomy (MT). Since hyperglycemia in AIS represents a dynamic condition, we tested whether the dynamic patterns of hyperglycemia, defined as blood glucose levels > 140 mg/dl, affect outcomes in these patients. METHODS We retrospectively analyzed data of 200 consecutive patients with prospective follow-up. Based on blood glucose level, patients were distinguished into 4 groups: (1) persistent normoglycemia; (2) hyperglycemia at baseline only; (3) hyperglycemia at 24-h only; and (4) persistent (at baseline plus at 24-h following MT) hyperglycemia. RESULTS AIS patients with persistent hyperglycemia have a significantly increased risk of poor functional outcome (OR 6.89, 95% CI 1.98-23.94, p = 0.002, for three-month poor outcome; OR 11.15, 95% CI 2.99-41.52, p = 0.001, for no major neurological improvement), mortality (OR 5.37, 95% CI 1.61-17.96, p = 0.006, for in-hospital mortality; OR 4.43, 95% CI 1.40-13.97, p = 0.01, for three-month mortality), and hemorrhagic transformation (OR 6.89, 95% CI 2.35-20.21, p = 0.001, for intracranial hemorrhage; OR 5.42, 95% CI 1.54-19.15, p = 0.009, for symptomatic intracranial hemorrhage) after endovascular treatment. These detrimental effects were partially confirmed after also excluding diabetic patients. The AUC-ROC showed a very good performance for predicting three-month poor outcome (0.76) in-hospital mortality (0.79) and three-month mortality (0.79). CONCLUSIONS Our study suggests that it is useful to perform the prolonged monitoring of glucose levels lasting 24-h after MT.
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49
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Sun C, Wu C, Zhao W, Wu L, Wu D, Li W, Wei D, Ma Q, Chen H, Ji X. Glycosylated Hemoglobin A1c Predicts Intracerebral Hemorrhage with Acute Ischemic Stroke Post-Mechanical Thrombectomy. J Stroke Cerebrovasc Dis 2020; 29:105008. [PMID: 32807423 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 05/27/2020] [Accepted: 05/28/2020] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Intracerebral hemorrhage, including symptomatic intracerebral hemorrhage, is a serious post-mechanical thrombectomy complication in patients with acute ischemic stroke. We aimed to determine whether glycosylated hemoglobin A1c parameters could predict intracerebral hemorrhage in this patient population. METHODS We enrolled patients with acute occlusion of the internal carotid artery or proximal middle cerebral artery and who had undergone mechanical thrombectomy. According to the glycosylated hemoglobin A1c level (%) assessed during the hospital stay, the patients were divided into two groups: > 6.5% and ≤ 6.5%. Intracerebral hemorrhage was evaluated and classified based on cranial computed tomography scans obtained within 24-48 h or when neurological conditions worsened. We assessed the outcome at the end of 90 days using the modified Rankin Scale scores. RESULTS Among 202 patients, 86 (42.6%) suffered intracerebral hemorrhage, while 25 (12.4%) had symptomatic intracerebral hemorrhage; 35.6% of the patients had a favorable outcome (modified Rankin Scale scores 0-2). Multivariable analysis demonstrated an association of glycosylated hemoglobin A1c > 6.5% with intracerebral hemorrhage. Furthermore, glycosylated hemoglobin A1c > 6.5% was independently associated with symptomatic intracerebral hemorrhage (OR, 2.136; 95% CI, 1.279-3.567; P = 0.004). In addition, glycosylated hemoglobin A1c > 6.5% was significantly associated with increased mortality (OR, 1.511; 95% CI, 1.042-2.191; P = 0.029) and negatively associated with favorable outcome (OR, 0.480; 95% CI, 0.296-0.781; P = 0.003) at 90 days. CONCLUSIONS Glycosylated hemoglobin A1c is an independent predictor of intracerebral hemorrhage (specifically, symptomatic intracerebral hemorrhage) in patients with acute ischemic stroke treated with mechanical thrombectomy. Further studies are needed to validate these findings.
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Affiliation(s)
- Chenghe Sun
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China; Affiliated Qiqihar Hospital, Southern Medical University, Qiqihar, China
| | - Chuanjie Wu
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Wenbo Zhao
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Longfei Wu
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Di Wu
- China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Weili Li
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Dongmei Wei
- The First Hospital of Qiqihar, Qiqihar, China; Affiliated Qiqihar Hospital, Southern Medical University, Qiqihar, China
| | - Qingfeng Ma
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Hong Chen
- The First Hospital of Qiqihar, Qiqihar, China; Affiliated Qiqihar Hospital, Southern Medical University, Qiqihar, China
| | - Xunming Ji
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.
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50
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Psychogios K, Magoufis G, Safouris A, Kargiotis O, Katsanos AH, Spiliopoulos S, Papageorgiou E, Palaiodimou L, Brountzos E, Stamboulis E, Tsivgoulis G. Eligibility for intravenous thrombolysis in acute ischemic stroke patients presenting in the 4.5-9 h window. Neuroradiology 2020; 62:733-739. [PMID: 32008046 DOI: 10.1007/s00234-020-02375-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 01/21/2020] [Indexed: 02/08/2023]
Abstract
PURPOSE Recent randomized-controlled clinical trials have provided preliminary evidence for expanding the time window of intravenous thrombolysis (IVT) in acute ischemic stroke (AIS) patients by applying certain neuroimaging criteria. We prospectively assessed the potential eligibility for IVT in the extended time window (4.5-9 h) among consecutive AIS patients treated in a comprehensive stroke center during a nine-month period. METHODS Potential eligibility for IVT in the extended time window was evaluated by using inclusion criteria from the EXTEND trial. All patients were underwent baseline emergent neurovascular imaging using either computed tomography angiography/computed tomography perfusion (CTA/CTP) or magnetic resonance angiography/magnetic resonance perfusion (MRA/MRP). Images were post processed by the automated software RAPID. RESULTS Our study population consisted of 317 AIS patients, and, among them, 31 (9.8 %) patients were presented in the time window of 4.5-9 h. Seven patients (2.2 %) fulfilled the EXTEND neuroimaging criteria. Four patients (1.3 %) were treated with IVT because they fulfilled both clinical and neuroimaging EXTEND criteria. Patients eligible for EXTEND neuroimaging criteria had no ischemic core lesion, whereas the mean volume of critical hypoperfusion was relatively small (17.0 ± 11.8 ml). There was no hemorrhagic complication in any of the patients treated with IVT. The median mRS score at three months was 0 (range: 0-3) among patients who were eligible for EXTEND neuroimaging criteria. CONCLUSION Our everyday clinical practice experience suggests 9.8 % of consecutive AIS patients present in the 4.5-9 h window and 2.2 % adhere to EXTEND neuroimaging eligibility criteria for IVT. Only 1.3% of AIS is eligible for IVT according to EXTEND neuroimaging and clinical eligibility criteria.
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Affiliation(s)
- Klearchos Psychogios
- Acute Stroke Unit, Metropolitan Hospital, Piraeus, Greece.
- Second Department of Neurology, "Attikon University Hospital", School of Medicine, University of Athens, Athens, Greece.
| | - Georgios Magoufis
- Department of Interventional Neuroradiology, Metropolitan Hospital, Piraeus, Greece
| | - Apostolos Safouris
- Acute Stroke Unit, Metropolitan Hospital, Piraeus, Greece
- Second Department of Neurology, "Attikon University Hospital", School of Medicine, University of Athens, Athens, Greece
| | | | - Aristeidis H Katsanos
- Second Department of Neurology, "Attikon University Hospital", School of Medicine, University of Athens, Athens, Greece
| | - Stavros Spiliopoulos
- Second Department of Radiology, Interventional Radiology Unit, "ATTIKON" University General Hospital, Athens, Greece
| | | | - Lina Palaiodimou
- Second Department of Neurology, "Attikon University Hospital", School of Medicine, University of Athens, Athens, Greece
| | - Elias Brountzos
- Second Department of Radiology, Interventional Radiology Unit, "ATTIKON" University General Hospital, Athens, Greece
| | | | - Georgios Tsivgoulis
- Second Department of Neurology, "Attikon University Hospital", School of Medicine, University of Athens, Athens, Greece
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