Diabetes Mellitus, Admission Glucose, and Outcomes After Stroke Thrombolysis

Desilles, Jean‐Philippe; Meseguer, Elena; Labreuche, Julien; Lapergue, Bertrand; Gaia, Silvia; Gonzalez‐Valcarcel, Jaime; Lavallée, Philippa C.; Cabrejo, Lucie; Guidoux, Céline; Klein, Isabelle; Amarenco, Pierre; Mazighi, Mikaël

doi:10.1161/strokeaha.111.000813

Cited by 183 publications

(143 citation statements)

References 50 publications

(13 reference statements)

Supporting

Mentioning

132

Contrasting

Unclassified

Order By: Relevance

“…In the present study, DM is associated with a significantly lower frequency of a favorable clinical outcome (mRs 0-2) and higher mortality at the 3rd month after AIS.The results are similar to those of a number of unadjusted studies (12,13). A significant correlation between DM and ICH is not proven.…”

Section: Discussionsupporting

confidence: 79%

Impact of diabetes mellitus and admission hyperglycemia on outcomes after intravenous thrombolysis in acute ischemic stroke patients

Kalevska

Andonova²,

Georgieva-Hristova³

et al. 2016

SSM

View full text Add to dashboard Cite

Diabetes mellitus (DM) is a major risk factor for stroke, which is associated with unfavorable outcome after acute ischemic stroke (AIS) and disability. The potential harmful effect of DM, and the role and importance of blood glucose (BG) at admission are currently unclear for a clinical outcome after АIS. The aim of this study is to look for correlations between the presence of DM and the initial level of BG, and the clinical outcome after an intravenous thrombolysis (IVT) in patients with acute AIS. MATERIALS AND METHODS: CONCLUSION:Patients with DM have significantly higher mortality and lack of favorable functional outcome at the third month compared to those without DM, which cannot be explained by the presence of ICH. The initial HG is not significantly associated with an unfavorable clinical outcome, but it quickly identifies patients with an increased risk of such an outcome in whom the blood sugar levels should be closely monitored.

show abstract

Section: Discussionsupporting

confidence: 79%

Impact of diabetes mellitus and admission hyperglycemia on outcomes after intravenous thrombolysis in acute ischemic stroke patients

Kalevska

Andonova²,

Georgieva-Hristova³

et al. 2016

SSM

View full text Add to dashboard Cite

show abstract

“…[323][324][325][326][327][328] Furthermore, hyperglycemia may accelerate tissue infarction after ischemia and decreases the chances of successful recanalization. 329,330 It is worth noting, however, that persistent hyperglycemia, rather than baseline hyperglycemia alone, may be more important in predicting these adverse outcomes.…”

Section: Blood Glucosementioning

confidence: 99%

Scientific Rationale for the Inclusion and Exclusion Criteria for Intravenous Alteplase in Acute Ischemic Stroke

Demaerschalk¹,

Kleindorfer²,

Adeoye³

et al. 2016

Stroke

564

237

View full text Add to dashboard Cite

Purpose-To critically review and evaluate the science behind individual eligibility criteria (indication/inclusion and contraindications/exclusion criteria) for intravenous recombinant tissue-type plasminogen activator (alteplase) treatment in acute ischemic stroke. This will allow us to better inform stroke providers of quantitative and qualitative risks associated with alteplase administration under selected commonly and uncommonly encountered clinical circumstances and to identify future research priorities concerning these eligibility criteria, which could potentially expand the safe and judicious use of alteplase and improve outcomes after stroke. Methods-Writing group members were nominated by the committee chair on the basis of their previous work in relevant topic areas and were approved by the American Heart Association Stroke Council's Scientific Statement Oversight Committee and the American Heart Association's Manuscript Oversight Committee. The writers used systematic literature reviews, references to published clinical and epidemiology studies, morbidity and mortality reports, clinical and public health guidelines, authoritative statements, personal files, and expert opinion to summarize existing evidence and to indicate gaps in current knowledge and, when appropriate, formulated recommendations using standard American Heart Association criteria. All members of the writing group had the opportunity to comment on and approved the final version of this document. The document underwent extensive American Heart Association internal peer review, Stroke The American Heart Association makes every effort to avoid any actual or potential conflicts of interest that may arise as a result of an outside relationship or a personal, professional, or business interest of a member of the writing panel. Specifically, all members of the writing group are required to complete and submit a Disclosure Questionnaire showing all such relationships that might be perceived as real or potential conflicts of interest.This statement was approved by the American Heart Association Science Advisory and Coordinating Committee on September 24, 2015, and the American Heart Association Executive Committee on October 5, 2015. A copy of the document is available at http://my.americanheart.org/statements by selecting either the "By Topic" link or the "By Publication Date" link. To purchase additional reprints, call 843-216-2533 or e-mail kelle.ramsay@ wolterskluwer.com.The online-only Data Supplement, which contains literature search strategies and Figures A, B, and C, is available with this article at http://circ. ahajournals.org/lookup/suppl/doi:10.1161/STR.0000000000000086/-/DC1.The American Heart Association requests that this document be cited as follows: Demaerschalk BM, Kleindorfer DO, Adeoye OM, Demchuk AM, Fugate JE, Grotta JC, Khalessi AA, Levy EI, Palesch YY, Prabhakaran S, Saposnik G, Saver JL, Smith EE; on behalf of the American Heart Association Stroke Council and Council on Epidemiology and Prevention. Scientific rational...

show abstract

“…Among them, hyperglycemia has been found to be associated with hemorrhagic transformation (HT) and worsened neurological outcomes. 1,2 Given that 40% to 50% of AIS patients present with hyperglycemia, 3 understanding and reducing hyperglycemia-induced neurovascular injury constitute an important clinical stake. Experimental studies have investigated extensively the relationship between hyperglycemia and poor outcome after AIS.…”

mentioning

confidence: 99%

Exacerbation of Thromboinflammation by Hyperglycemia Precipitates Cerebral Infarct Growth and Hemorrhagic Transformation

Desilles

Syvannarath

Ollivier

et al. 2017

Stroke

Self Cite

113

View full text Add to dashboard Cite

A cute ischemic stroke (AIS) remains a leading cause of disability, cognitive impairment, and mortality worldwide, despite the development of revascularization therapies. Besides recanalization status, other prognostic factors in AIS patients are associated with clinical outcome. Among them, hyperglycemia has been found to be associated with hemorrhagic transformation (HT) and worsened neurological outcomes. 1,2 Given that 40% to 50% of AIS patients present with hyperglycemia, 3 understanding and reducing hyperglycemia-induced neurovascular injury constitute an important clinical stake. Experimental studies have investigated extensively the relationship between hyperglycemia and poor outcome after AIS. [4][5][6] Notably, these studies have shown that preexisting hyperglycemia, whether acute or prolonged, was an important determinant of brain injury in AIS. In contrast, hyperglycemia induced after the period of ischemia had no effect on experimental stroke outcome.5 Hyperglycemia was further shown to increase cerebral ischemia-reperfusion-induced blood-brain Background and Purpose-Admission hyperglycemia is associated with a poor outcome in acute ischemic stroke. How hyperglycemia impacts the pathophysiology of acute ischemic stroke remains largely unknown. We investigated how preexisting hyperglycemia increases ischemia/reperfusion cerebral injury. Methods-Normoglycemic and streptozotocin-treated hyperglycemic rats were subjected to transient middle cerebral artery occlusion. Infarct growth and brain perfusion were assessed by magnetic resonance imaging. Markers of platelet, coagulation, and neutrophil activation were measured in brain homogenates and plasma. Downstream microvascular thromboinflammation (DMT) was investigated by intravital microscopy. Results-Hyperglycemic rats had an increased infarct volume with an increased blood-brain barrier disruption and hemorrhagic transformation rate compared with normoglycemic rats. Magnetic resonance imaging scans revealed that hyperglycemia enhanced and accelerated lesion growth and was associated with hemorrhagic transformation originating from territories that were still not completely reperfused at 1 hour after middle cerebral artery recanalization. Intravital microscopy and analysis of brain homogenates showed that DMT began immediately after middle cerebral artery occlusion and was exacerbated by hyperglycemia. Measurement of plasma serotonin and matrix metalloproteinase-9 indicated that platelets and neutrophils were preactivated in hyperglycemic rats. Neutrophils from hyperglycemic diabetic patients showed increased adhesion to endothelial cells as compared with neutrophils from normoglycemic donors in flow chamber experiments. Conclusions-We show that hyperglycemia primes the thromboinflammatory cascade, thus, amplifying middle cerebral artery occlusion-induced DMT. DMT exacerbation in hyperglycemic rats impaired reperfusion and precipitated neurovascular damage, blood-brain barrier disruption, and hemorrhagic transformation. Our results designate DMT as a po...

show abstract

Diabetes Mellitus, Admission Glucose, and Outcomes After Stroke Thrombolysis

Cited by 183 publications

References 50 publications

Impact of diabetes mellitus and admission hyperglycemia on outcomes after intravenous thrombolysis in acute ischemic stroke patients

Impact of diabetes mellitus and admission hyperglycemia on outcomes after intravenous thrombolysis in acute ischemic stroke patients

Scientific Rationale for the Inclusion and Exclusion Criteria for Intravenous Alteplase in Acute Ischemic Stroke

Exacerbation of Thromboinflammation by Hyperglycemia Precipitates Cerebral Infarct Growth and Hemorrhagic Transformation

Contact Info

Product

Resources

About