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2020-06-29

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cc-by (c) Laredo, Carlos et al., 2020
Si us plau utilitzeu sempre aquest identificador per citar o enllaçar aquest document: https://hdl.handle.net/2445/168357

Elevated glucose is associated with hemorrhagic transformation after mechanical thrombectomy in acute ischemic stroke patients with severe pretreatment hypoperfusion

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Recurs relacionat

https://doi.org/10.1038/s41598-020-67448-x

Resum

Several pretreatment variables such as elevated glucose and hypoperfusion severity are related to brain hemorrhage after endovascular treatment of acute stroke. We evaluated whether elevated glucose and severe hypoperfusion have synergistic effects in the promotion of parenchymal hemorrhage (PH) after mechanical thrombectomy (MT). We included 258 patients MT-treated who had a pretreatment computed tomography perfusion (CTP) and a post-treatment follow-up MRI. Severe hypoperfusion was defined as regions with cerebral blood volume (CBV) values < 2.5% of normal brain [very-low CBV (VLCBV)-regions]. Median baseline glucose levels were 119 (IQR = 105-141) mg/dL. Thirty-nine (15%) patients had pretreatment VLCBV-regions, and 42 (16%) developed a PH after MT. In adjusted models, pretreatment glucose levels interacted significantly with VLCBV on the prediction of PH (p-interaction = 0.011). In patients with VLCBV-regions, higher glucose was significantly associated with PH (adjusted-OR = 3.15; 95% CI = 1.08-9.19, p = 0.036), whereas this association was not significant in patients without VLCBV-regions. CBV values measured at pretreatment CTP in coregistered regions that developed PH or infarct at follow-up were not correlated with pretreatment glucose levels, thus suggesting the existence of alternative deleterious mechanisms other than direct glucose-driven hemodynamic impairments. Overall, these results suggest that both severe hypoperfusion and glucose levels should be considered in the evaluation of adjunctive neuroprotective strategies.

Matèries

Embòlia i trombosi cerebral, Isquèmia cerebral, Glucèmia, Tomografia, Imatges per ressonància magnètica

Matèries (anglès)

Cerebral embolism and thrombosis, Cerebral ischemia, Blood sugar, Tomography, Magnetic resonance imaging

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Articles publicats en revistes (Cirurgia i Especialitats Medicoquirúrgiques)
Articles publicats en revistes (IDIBAPS: Institut d'investigacions Biomèdiques August Pi i Sunyer)

Citació

LAREDO, Carlos, RENÚ, Arturo, LLULL, Laura, TUDELA FERNÁNDEZ, Raúl, LÓPEZ RUEDA, Antonio, URRA, Xabier, MACÍAS, Napoleón g., RUDILOSSO, Salvatore, OBACH, Víctor, AMARO, Sergio, CHAMORRO SÁNCHEZ, Ángel. Elevated glucose is associated with hemorrhagic transformation after mechanical thrombectomy in acute ischemic stroke patients with severe pretreatment hypoperfusion. _Scientific Reports_. 2020. Vol. 10, núm. 10588. [consulta: 30 de gener de 2026]. ISSN: 2045-2322. [Disponible a: https://hdl.handle.net/2445/168357]

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