Shadi Yaghi1, Seena Dehkharghani2, Eytan Raz3, Mahesh Jayaraman4, Omar Tanweer5, Brian Mac Grory6, Nils Henninger7, Maarten G Lansberg8, Gregory W Albers9, Adam de Havenon10. 1. Department of Neurology, NYU Langone Health, 150 55th St Suite 3667, Brooklyn, NY 11220, USA. Electronic address: Shadi.yaghi@nyulangone.org. 2. Department of Radiology, NYU Langone Health, New York, NY, United States. Electronic address: Seena.Dehkharghani@nyulangone.org. 3. Department of Radiology, NYU Langone Health, New York, NY, United States. Electronic address: Eytan.raz@nyulangone.org. 4. 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. Electronic address: Mahesh.jayaraman@gmail.com. 5. Department of Neurosurgery, NYU Langone Health, New York, NY, United States. Electronic address: Omar.tanweer@nyulangone.org. 6. Department of Neurology, Duke University, Durham, NC, United States. Electronic address: brian.macgrory@duke.edu. 7. Department of Neurology, University of Massachusetts, Worcester, MA, United States; Department of Psychiatry, University of Massachusetts, Worcester, MA, United States. Electronic address: nils.henninger@umassmed.edu. 8. Department of Neurology, Stanford University, San Francisco, CA, United States. Electronic address: Lansberg@stanford.edu. 9. Department of Neurology, Stanford University, San Francisco, CA, United States. Electronic address: albers@stanford.edu. 10. Department of Neurology, University of Utah Medical Center, Salt Lake City, UT, United States. Electronic address: adam.dehavenon@hsc.utah.edu.
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.
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.
Authors: Brian Mac Grory; Jonathan P Piccini; Shadi Yaghi; Sven Poli; Adam De Havenon; Sara K Rostanski; Martin Weiss; Ying Xian; S Claiborne Johnston; Wuwei Feng Journal: J Am Heart Assoc Date: 2022-01-19 Impact factor: 6.106