Effect of hyperglycemia on stroke outcome is not homogeneous to all patients treated with mechanical thrombectomy

Autor: Laurent Suissa, Emmanuelle Robinet-Borgomano, Sébastien Gazzola, Nadia Laksiri, Jean Pelletier, Anthony Faivre, Caroline Rey, Gwendoline Romero, Charline Perot, Emilie Panicucci, Marie-Hélène Mahagne, Emilie Doche
Přispěvatelé: Stroke Unit - University Hospital of Nice, Laboratoire TIRO, UMR E4320, Faculté de Médecine Université Côte d'Azur, Stroke Unit, University Hospital Timone, APHM, Marseille, Stroke Unit - Teaching Military Hospital of Toulon, Centre de résonance magnétique biologique et médicale (CRMBM), Aix Marseille Université (AMU)-Assistance Publique - Hôpitaux de Marseille (APHM)-Centre National de la Recherche Scientifique (CNRS), Centre d'Exploration Métabolique par Résonance Magnétique [Hôpital de la Timone - APHM] (CEMEREM), Hôpital de la Timone [CHU - APHM] (TIMONE)-Centre de résonance magnétique biologique et médicale (CRMBM), Aix Marseille Université (AMU)-Assistance Publique - Hôpitaux de Marseille (APHM)-Centre National de la Recherche Scientifique (CNRS)-Aix Marseille Université (AMU)-Assistance Publique - Hôpitaux de Marseille (APHM)-Centre National de la Recherche Scientifique (CNRS)
Jazyk: angličtina
Rok vydání: 2020
Předmět:
Blood Glucose
Male
medicine.medical_specialty
medicine.medical_treatment
Tissue plasminogen activator
law.invention
03 medical and health sciences
0302 clinical medicine
Randomized controlled trial
[SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system
Modified Rankin Scale
law
Internal medicine
medicine
Humans
Stroke
ComputingMilieux_MISCELLANEOUS
Aged
Ischemic Stroke
Retrospective Studies
Thrombectomy
Cerebral infarction
business.industry
Penumbra
Infarction
Middle Cerebral Artery
General Medicine
Thrombolysis
Recovery of Function
Middle Aged
medicine.disease
Mechanical thrombectomy
Treatment Outcome
030220 oncology & carcinogenesis
Hyperglycemia
Tissue Plasminogen Activator
Reperfusion
Cardiology
Surgery
Female
Neurology (clinical)
business
030217 neurology & neurosurgery
medicine.drug
Zdroj: Clinical Neurology and Neurosurgery
Clinical Neurology and Neurosurgery, 2020, 194, pp.105750. ⟨10.1016/j.clineuro.2020.105750⟩
ISSN: 0303-8467
DOI: 10.1016/j.clineuro.2020.105750⟩
Popis: Objectives Admission hyperglycemia is a penumbra-modifying factor that is associated with poor functional outcome in acute ischemic stroke (AIS) patients treated with intravenous rt-PA and/or mechanical thrombectomy (MT). Insulin therapy has failed to demonstrate a clinical benefit and the question of the patient selection remains under debate. We assessed the relationship between admission glycemia (AG) and functional outcome in AIS patients treated by MT according to both penumbra characteristics and reperfusion status. Patients and methods We performed a retrospective analysis of a multi-center registry of consecutive AIS (NIHSS ≥ 10) due to middle cerebral artery occlusion treated by MT (± tissue Plasminogen Activator (tPA)). To evaluate the association between AG and the 3-month functional outcome (modified Rankin Scale (mRS) ≤2), univariable and multivariable analyses were used. Subgroup analyses were performed according to both clinical-ASPECTS Mismatch (CAM2) and the complete recanalization (CR) status defined by a mTICI scale (modified Thrombolysis in Cerebral Infarction) 2b/3. Results 216 AIS patients were included (Median Age: 68.43[58.12–77.95], median NIHSS: 18[15–21]). 104/216 (48.15%) patients had mRS≤2 at 3 months. AG was an independent predictor of functional outcome (/1 g/L OR: 0.10[0.03–0.37]) after adjusting for potential cofounders. Among subgroups formed by combining CAM2 and CR, AG was found to be predictor of functional outcome only in CAM2+/CR+ and specifically when recanalization was early. Conclusion This study highlights the fact that the relationship between AG and prognosis is not homogeneous for all patients and indicates that AG has a deleterious effect on the ischemic penumbra, thus explaining its statistical association with functional outcome. Stroke neuroprotection by targeting hyperglycemia should be considered in acute stroke patients with mismatch and early complete recanalization. More prospective randomized trials are needed to generalize the conclusions.
Databáze: OpenAIRE
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