The correlation between admission blood glucose and intravenous rt-PA-induced arterial recanalization in acute ischemic stroke

A multi-centre TCD study

Maher Saqqur, Ashfaq Shuaib, Andrei Alexandrov, Joseph Sebastian, Khurshid Khan, Ken Uchino

Research output: Contribution to journalArticle

13 Citations (Scopus)

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 ≥140mg/dl (7·7mmol/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 (7·7mmol/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) (11mmol/l) and glucose <200 was 163±79 and 131±90mins, 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.

Original languageEnglish (US)
Pages (from-to)1087-1092
Number of pages6
JournalInternational Journal of Stroke
Volume10
Issue number7
DOIs
StatePublished - Oct 1 2015

Fingerprint

Hyperglycemia
Tissue Plasminogen Activator
Blood Glucose
Stroke
Odds Ratio
Confidence Intervals
Glucose
Cerebral Hemorrhage
National Institutes of Health (U.S.)
Brain Ischemia
Diabetes Mellitus
Arteries
Databases
Serum

All Science Journal Classification (ASJC) codes

  • Neurology

Cite this

The correlation between admission blood glucose and intravenous rt-PA-induced arterial recanalization in acute ischemic stroke : A multi-centre TCD study. / Saqqur, Maher; Shuaib, Ashfaq; Alexandrov, Andrei; Sebastian, Joseph; Khan, Khurshid; Uchino, Ken.

In: International Journal of Stroke, Vol. 10, No. 7, 01.10.2015, p. 1087-1092.

Research output: Contribution to journalArticle

@article{301da09748d64f31a3c988090aab9ddb,
title = "The correlation between admission blood glucose and intravenous rt-PA-induced arterial recanalization in acute ischemic stroke: A multi-centre TCD study",
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 ≥140mg/dl (7·7mmol/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 (7·7mmol/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) (11mmol/l) and glucose <200 was 163±79 and 131±90mins, 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.",
author = "Maher Saqqur and Ashfaq Shuaib and Andrei Alexandrov and Joseph Sebastian and Khurshid Khan and Ken Uchino",
year = "2015",
month = "10",
day = "1",
doi = "10.1111/ijs.12517",
language = "English (US)",
volume = "10",
pages = "1087--1092",
journal = "International Journal of Stroke",
issn = "1747-4930",
publisher = "Wiley-Blackwell",
number = "7",

}

TY - JOUR

T1 - The correlation between admission blood glucose and intravenous rt-PA-induced arterial recanalization in acute ischemic stroke

T2 - A multi-centre TCD study

AU - Saqqur, Maher

AU - Shuaib, Ashfaq

AU - Alexandrov, Andrei

AU - Sebastian, Joseph

AU - Khan, Khurshid

AU - Uchino, Ken

PY - 2015/10/1

Y1 - 2015/10/1

N2 - 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 ≥140mg/dl (7·7mmol/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 (7·7mmol/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) (11mmol/l) and glucose <200 was 163±79 and 131±90mins, 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.

AB - 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 ≥140mg/dl (7·7mmol/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 (7·7mmol/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) (11mmol/l) and glucose <200 was 163±79 and 131±90mins, 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.

UR - http://www.scopus.com/inward/record.url?scp=84942295645&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84942295645&partnerID=8YFLogxK

U2 - 10.1111/ijs.12517

DO - 10.1111/ijs.12517

M3 - Article

VL - 10

SP - 1087

EP - 1092

JO - International Journal of Stroke

JF - International Journal of Stroke

SN - 1747-4930

IS - 7

ER -