Short-term glycemic variability and hemorrhagic transformation after successful endovascular thrombectomy
- 12 February 2021
- journal article
- research article
- Published by Springer Science and Business Media LLC in Translational Stroke Research
- Vol. 12 (6), 968-975
- https://doi.org/10.1007/s12975-021-00895-4
Abstract
Background Glycemic variability (GV) is a risk factor for poor outcomes after ischemic stroke. However, its effect on hemorrhagic transformation after endovascular recanalization therapy (ERT) remains to be elucidated. Methods Patients with acute ischemic stroke due to large vessel occlusion with successful recanalization after ERT (modified thrombolysis in cerebral infarction 2b or 3) were enrolled between January 2013 and November 2019. Blood glucose level data were obtained during the first 36 h after ERT, and ten GV parameters including time rate (TR) of glucose variation were assessed. The TR of glucose variation reflects the speed of glucose fluctuations over time (mg/dL/hour) during the monitoring period. Symptomatic intracerebral hemorrhage (sICH) and unfavorable outcomes at 3 months after ERT were analyzed. The sICH was defined as parenchymal hematoma type 2 with a neurological deterioration of 4 points or more on the National Institute of Health Stroke Scale. Moreover, a modified Rankin Scale of 3–6 at 3 months was considered an unfavorable outcome. Results Among all patients (n = 176; mean age, 69.3 years; 47.7 % female), sICH developed after successful ERT in 16 (9.1%) patients. In addition, 54% (n = 95) patients had an unfavorable outcome at 3 months. Patients with sICH and unfavorable outcome had higher the TR of glucose variation. After adjusting for potential confounders, the TR of glucose (per 1 mg/dL/h increase) variation was independently associated with sICH (odds ratio, 1.17; 95% confidence interval [CI], 1.012–1.343) and 3-month unfavorable outcome (OR 1.14, 95% CI, 1.000–1.297). Conclusions Time-related GV during the first 36 h after successful ERT has a stronger correlation with sICH and poor functional outcomes compared to any GV parameters. This suggests that maintaining stable glucose may be an important factor in the prevention of sICH after undergoing successful ERT.Keywords
This publication has 50 references indexed in Scilit:
- Endovascular Reperfusion and Cooling in Cerebral Acute Ischemia (ReCCLAIM I)Journal of NeuroInterventional Surgery, 2013
- Hemorrhagic Transformation: A Review of the Rate of Hemorrhage in the Major Clinical Trials of Acute Ischemic StrokeFrontiers in Neurology, 2013
- Glycemic variability: Clinical implicationsIndian Journal of Endocrinology and Metabolism, 2013
- Glucose fluctuations in subjects with normal glucose tolerance, impaired glucose regulation and newly diagnosed type 2 diabetes mellitusClinical Endocrinology, 2012
- Dynamic of Hyperglycemia as a Predictor of Stroke Outcome in the ECASS-II TrialStroke, 2008
- Oscillating Glucose Is More Deleterious to Endothelial Function and Oxidative Stress Than Mean Glucose in Normal and Type 2 Diabetic PatientsDiabetes, 2008
- Trial Design and Reporting Standards for Intra-Arterial Cerebral Thrombolysis for Acute Ischemic StrokeStroke, 2003
- Stress Hyperglycemia and Prognosis of Stroke in Nondiabetic and Diabetic PatientsStroke, 2001
- Hemorrhagic Transformation Within 36 Hours of a Cerebral InfarctStroke, 1999
- Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment.Stroke, 1993