Prediction of adverse outcomes by blood glucose level after endovascular therapy for acute ischemic stroke

Natarajan, Sabareesh K.; Dandona, Paresh; Karmon, Yuval; Yoo, Albert J.; Kalia, Junaid S.; Hao, Qing; Hsu, Daniel P.; Hopkins, L. Nelson; Fiorella, David; Bendok, Bernard R.; Nguyen, Thanh N.; Rymer, Marilyn M.; Nanda, Ashish; Liebeskind, David S; Zaidat, Osama O.; Nogueira, Raul G; Siddiqui, Adnan H.; Levy, Elad I.

doi:10.3171/2011.1.jns10884

Cited by 35 publications

(33 citation statements)

References 32 publications

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“…4,10,14,29,35,43,,45,49,54 Of them, one reported a positive association with favorable outcome but not with excellent outcome. 14 Regarding mortality (11 studies, n=19979), an increase risk of death associated with higher AGL was reported in 6 studies (n=18940) 4,10,14,24,35,45,49 which remained significant after adjustment in 5 studies. Regarding sICH (18 studies, n=23794), an increase risk associated with higher AGL was reported in 7 studies (n=19659) 5,32,37,40,49,53,55 which was significant in multivariate analysis for 3 studies (n=16647).…”

mentioning

confidence: 98%

Diabetes Mellitus, Admission Glucose, and Outcomes After Stroke Thrombolysis

Desilles

Meseguer

Labreuche

et al. 2013

Stroke

183

129

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Background and Purpose-The potential detrimental effect of diabetes mellitus and admission glucose level (AGL) on outcomes after stroke thrombolysis is unclear. We evaluated outcomes of patients treated by intravenous and/or intraarterial therapy, according to diabetes mellitus and AGL. Methods-We analyzed data from a patient registry (n=704) and conducted a systematic review of previous observational studies. The primary study outcome was the percentage of patients who achieved a favorable outcome (modified Rankin score ≤2 at 3 months). Results-We identified 54 previous reports that evaluated the effect of diabetes mellitus or AGL on outcomes after thrombolysis. In an unadjusted meta-analysis that included our registry data and previous available observational data, diabetes mellitus was associated with less favorable outcome (odds ratio

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mentioning

confidence: 98%

Diabetes Mellitus, Admission Glucose, and Outcomes After Stroke Thrombolysis

Desilles

Meseguer

Labreuche

et al. 2013

Stroke

183

129

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“…According to previous studies, risk factors for ICH after ER include atrial fibrillation, 15,16) diabetes mellitus/hyperglycemia, 1,15,17) old cerebral infarction of the basal ganglia, 18) and leukoaraiosis. 19) Although the oral administration of anticoagulants prior to onset was also a risk factor in the present study, its contribution to ICH after ER was controversial in previous studies.…”

Section: Background Factors Before Onsetmentioning

confidence: 99%

Intracranial Hemorrhage after Endovascular Revascularization for Acute Ischemic Stroke

Arimura

Imamura

Todo

et al. 2017

JNET

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Objective: Intracranial hemorrhage (ICH) after endovascular revascularization (ER) for acute ischemic stroke is associated with poor outcome. In this study, we examined the risk factors for postoperative ICH in patients who underwent ER in our hospital. Methods:We investigated the incidence/type of postoperative ICH and risk factors in 157 patients who underwent ER in our hospital from July 2011 to June 2015.Results: Postoperative ICH, including asymptomatic ICH, was observed in 57 (36.3%) patients. Symptomatic ICH occurred in seven patients (4.5%). According to the Safe Implementation of Thrombolysis in Stroke-Monitoring Study classification, hemorrhagic infarction type 2 and parenchymal hematoma type 2 were observed in 27 (47.4%) and 4 (7.0%) patients, respectively, of all patients with ICH. The frequency of patients with functional independence (score of 0-2 on the modified Rankin scale) 90 days after ER was significantly lower in patients with than without ICH (p <0.01).We performed a multivariate analysis of factors associated with postoperative ICH. The oral administration of anticoagulants prior to onset (p = 0.019; odds ratio [OR], 3.17; 95% confidence interval [CI], 1.22-8.54) and a prolonged onset-to-recanalization time (p = 0.043; OR, 1.11; 95% CI, 1.01-1.24) were associated with poor outcome.Conclusion: ICH after ER may lead to an unfavorable outcome. Risk factors for ICH after ER included the oral administration of anticoagulants prior to onset and a prolonged onset-to-recanalization time.

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“…8,38,46 Another important modifiable risk factor is glucose control. 9,35 Hyperglycemia is responsible for blood-brain barrier damage through increased production of lactic acid and free radicals, as well as direct damage to the lipid-rich neuronal membrane. 30 The desired range of blood glucose values is 80-140 mg/dl.…”

Section: Clinical and Laboratory Predictorsmentioning

confidence: 99%

Intracerebral hemorrhage secondary to intravenous and endovascular intraarterial revascularization therapies in acute ischemic stroke: an update on risk factors, predictors, and management

Mokin¹,

Kan

Kass‐Hout³

et al. 2012

FOC

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Intracerebral hemorrhage (ICH) secondary to intravenous and intraarterial revascularization strategies for emergent treatment of acute ischemic stroke is associated with high mortality. ICH from systemic thrombolysis typically occurs within the first 24–36 hours of treatment initiation and is characterized by rapid hematoma development and growth. Pathophysiological mechanisms of revascularization therapy-induced ICH are complex and involve a combination of several distinct processes, including the direct effect of thrombolytic agents, disruption of the blood-brain barrier secondary to ischemia, and direct vessel damage from wire and microcatheter manipulations during endovascular procedures. Several definitions of ICH secondary to thrombolysis currently exist, depending on clinical or radiological characteristics used. Multiple studies have investigated clinical and laboratory risk factors associated with higher rates of ICH in this setting. Early ischemic changes seen on noncontrast CT scanning are strongly associated with higher rates of hemorrhage. Modern imaging techniques, particularly CT perfusion, provide rapid assessment of hemodynamic parameters of the brain. Specific patterns of CT perfusion maps can help identify patients who are likely to benefit from revascularization or to develop hemorrhagic complications. There are no established guidelines that describe management of revascularization therapy–induced ICH, and great variability in treatment protocols currently exist. General principles that apply to the management of spontaneous ICH might not be as effective for revascularization therapy–induced ICH. In this article, the authors review current knowledge of risk factors and radiological predictors of ICH secondary to stroke revascularization techniques and analyze medical and surgical management strategies for ICH in this setting.

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Prediction of adverse outcomes by blood glucose level after endovascular therapy for acute ischemic stroke

Abstract: Failure of blood glucose values to decrease in the first 48 hours after AIS intervention correlated with poor 90-day outcomes in nondiabetic patients. The BRANCH scale shows promise as a simple prognostication tool after endovascular therapy for AIS, and it merits prospective validation.

Cited by 35 publications

References 32 publications

Diabetes Mellitus, Admission Glucose, and Outcomes After Stroke Thrombolysis

Diabetes Mellitus, Admission Glucose, and Outcomes After Stroke Thrombolysis

Intracranial Hemorrhage after Endovascular Revascularization for Acute Ischemic Stroke

Intracerebral hemorrhage secondary to intravenous and endovascular intraarterial revascularization therapies in acute ischemic stroke: an update on risk factors, predictors, and management

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