Clinical Outcome After Mechanical Thrombectomy in Patients with Diabetes with Major Ischemic Stroke of the Anterior Circulation
| Autor: | Jan Borggrefe, Gereon R. Fink, Volker Maus, Utako Birgit Barnikol, Anastasios Mpotsaris, Özgür A. Onur, Christoph Kabbasch, Berit Glück, Nuran Abdullayev |
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| Rok vydání: | 2018 |
| Předmět: |
Blood Glucose
Male Middle Cerebral Artery medicine.medical_specialty Collateral Circulation Comorbidity 030204 cardiovascular system & hematology Severity of Illness Index Brain Ischemia 03 medical and health sciences 0302 clinical medicine Modified Rankin Scale Diabetes mellitus medicine.artery Internal medicine Diabetes Mellitus medicine Humans In patient cardiovascular diseases Stroke Aged Thrombectomy Aged 80 and over business.industry Penumbra Age Factors Infarction Middle Cerebral Artery Middle Aged medicine.disease Mechanical thrombectomy Logistic Models Treatment Outcome Case-Control Studies Hyperglycemia Multivariate Analysis Middle cerebral artery Cardiology Female Surgery Neurology (clinical) business Perfusion Carotid Artery Internal 030217 neurology & neurosurgery |
| Zdroj: | World Neurosurgery. 120:e212-e220 |
| ISSN: | 1878-8750 |
| DOI: | 10.1016/j.wneu.2018.08.032 |
| Popis: | Among patients with acute ischemic stroke treated with mechanical thrombectomy (MT), patients with diabetes (DP) show a poorer outcome compared with patients without diabetes (NDP). This study aims to provide a comprehensive analysis of factors associated with unfavorable outcome in DP receiving MT for stroke of the anterior circulation.This study included 317 of 498 consecutive patients who received interventional treatment for acute ischemic stroke in the terminal internal carotid artery and/or middle cerebral artery, including 46 DP. The study data included pre- and posttreatment stroke computed tomography, including perfusion data, collateral status, treatment data including treatment times, pre-existing cardiovascular risk factors, cerebrovascular events, comorbidities, laboratory parameters, and medication. Neurologic status was assessed at baseline (National Institute of Health Stroke Scale [NIHSS]/modified Rankin Scale [mRS]) and after 90 days (mRS 90).Compared with NDP, DP showed a significantly poorer outcome (mRS902) (P0.05). Collateralization and infarct core size did not differ between groups, whereas the penumbra was significantly smaller in DP than in NDP (P0.05). The poorer mRS90 outcome (mRS902) in DP was associated with poor collaterals (P = 0.01) and hyperglycemia on admission (P0.05). Shorter time to reperfusion was associated with favorable mRS90 in the NDP (P0.001) but not the DP (P = 0.49) group. In univariate logistic regression, the following parameters were significantly associated with mRS90: diabetes, hyperglycemia at admission, time to reperfusion, and the NIHSS score (P0.05 each). In multivariate analyses and partition regression models of all variables, DP with admission hyperglycemia (≥132 mg/dL) and older age (≥66 years) showed a particularly poor outcome.The main factors for an unfavorable outcome of DP after MT are admission hyperglycemia, age, and NIHSS score. |
| Databáze: | OpenAIRE |
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