The Correlation between Admission Blood Glucose and Intravenous rt-PA-Induced Arterial Recanalization in Acute Ischemic Stroke: A Multi-Centre TCD Study. Issue 7 (October 2015)

• Record Type: Journal Article
• Authors: Saqqur, Maher; Shuaib, Ashfaq; Alexandrov, Andrei V.; Sebastian, Joseph; Khan, Khurshid; Uchino, Ken
• Is Part Of: International journal of stroke. Volume 10:Issue 7(2015:Oct.)
• Page Start: 1087
• Page End: 1092
• Publication Date: 2015-10
• Subjects: acute stroke therapy -- ischemic stroke -- rt-PA -- thrombolysis -- treatment -- ultrasound; 616.8005
• DOI: 10.1111/ijs.12517
• Languages: English
• ISSNs: 1747-4930

Abstract

Background: The relationship between hyperglycemia and arterial recanalization following intravenous recombinant tissue-plasminogen activator treatment in acute ischemic stroke is not well understood. Aim: We aimed to evaluate the effects of hyperglycemia in thrombolysed ischemic stroke patients on recanalization rate and clinical outcome. Methods: We studied 348 (231 subjects from the CLOTBUST databank and 117 subjects from the CLOTBUST trial phase II) with documented intracranial artery occlusion treated with intravenous recombinant tissue-plasminogen activator. Serum glucose was determined at baseline before intravenous recombinant tissue-plasminogen activator administration. Hyperglycemia was defined as a glucose level ≥140 mg/dl (7·7 mmol/l). Transcranial Doppler findings were interpreted using the thrombolysis in brain ischemia flow grading system as persistent arterial occlusion, re-occlusion or complete recanalization. Poor clinical outcome was defined by modified Rankin score > 2 at three-months. Results: At baseline, 138 patients (37·4%) were hyperglycemic and 210 patients (56·9%) normoglycemic. Baseline characteristics based on glucose ≥ 140 (7·7 mmol/l) or less 140: age (70·0 ± 12·4 vs. 67·3 ± 14·1, P = 0·065), baseline National Institutes of Health Stroke Scale (17·0 ± 5·5 vs. 15·8 ± 5·5, P = 0·054), time to recombinant tissue-plasminogen activator (141·4 ± 69·1 vs. 145·3 ± 48·4 mins, P = 0·56), and history of diabetes mellitus [60/138 (43·5%) vs. 22/210 (10·5%), P < 0·001]). Patients with hyperglycemia have a higher rate of persisting occlusion [72/138 (52·2%) vs. 66/210 (31·4%)] and less rate of complete recanalization [34/138 (24·6%) vs. 82/210 (39%), P < 0·001]. Median time to recanalization in patients with severe hyperglycemia (glucose ≥ 200) (11 mmol/l) and glucose <200 was 163 ± 79 and 131 ± 90 mins, respectively ( P = 0·045). Sixteen patients (11·6%) in the hyperglycemic group and 12 (5·7%) in the normoglycemic group had symptomatic intracerebral hemorrhage ( P = 0·049). Seventy-eight patients (69%) in the hyperglycemia group and 72 patients (41·6%) in the normoglycemic group had poor clinical outcome (three-month modified Rankin score > 2) ( P ≤ 0·001). After adjusting for stroke risk factors, patients with hyperglycemia were more likely to have poor clinical outcome (three-month modified Rankin score > 2) (adjusted odds ratio = 2·22, 95% confidence interval: 1·2–4·11, P = 0·011) and low complete recanalization rate (adjusted odds ratio: 0·5, confidence interval: 0·3–0·92, P = 0·025) with trend of increase risk of symptomatic intracerebral hemorrhage (adjusted odds ratio: 2·07, confidence interval:0·8–5·1, P = 0·114). There was no association between baseline glucose as a continuous variable and poor clinical outcome, but there was with the complete recanalization's rate. Conclusion: Hyperglycemia is associated with low rate of complete recanalization and poor clinical outcome in intravenous recombinant tissue-plasminogen activator-treated patients. Further studies are needed to evaluate whether lowering hyperglycemia is beneficial in the management of acute stroke patients.