Association of Blood Glucose and Clinical Outcome after Mechanical Thrombectomy for Acute Ischemic Stroke

Background: Elevated blood glucose levels following acute ischemic stroke have been associated with adverse clinical outcomes in thrombolytic and nonthrombolytic treated patients. The current study examined multiple blood glucose parameters and their association with modified Rankin Scale (mRS) score at 3 months following mechanical thrombectomy and hospital discharge. Methods: Acute ischemic stroke patients undergoing mechanical thrombectomy with a retrievable stent at two stroke centers were studied. Admission blood glucose level, maximum blood glucose during the hospital stay, and serial blood glucose measurements within the first 24 h of hospital admission were recorded. Variability in blood glucose level was represented by the standard deviation of the serial measurements within the first 24 h. The following demographic and clinical data was also collected: age, sex, baseline NIHSS score, onset-to-reperfusion times, hemoglobin A1c, and stroke mechanism. Results: 79 patients were identified; at 3 months, 35 patients had an mRS score of 0–2 and 44 had had an mRS of 3–6. Among the blood glucose variables, standard deviation of blood glucose in the first 24 h following admission and maximum blood glucose during hospital stay were significantly higher in the mRS 3–6 group. In multivariate logistic regression analysis, only the standard deviation of blood glucose remained significant (OR = 1.07, 95% CI = 1.02–1.11, p = 0.003) in a model that adjusted for admission NIHSS score (p = 0.016) and number of stent retriever passes (p = 0.042). Conclusions: Greater blood glucose variability following acute ischemic stroke is associated with worse clinical outcome in patients undergoing mechanical thrombectomy.

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Prediction of adverse outcomes by blood glucose level after endovascular therapy for acute ischemic stroke

Journal of Neurosurgery ◽

10.3171/2011.1.jns10884 ◽

2011 ◽

Vol 114 (6) ◽

pp. 1785-1799 ◽

Cited By ~ 13

Author(s):

Sabareesh K. Natarajan ◽

Paresh Dandona ◽

Yuval Karmon ◽

Albert J. Yoo ◽

Junaid S. Kalia ◽

...

Keyword(s):

Ischemic Stroke ◽

Blood Glucose ◽

Blood Glucose Level ◽

Acute Ischemic Stroke ◽

Glucose Level ◽

Endovascular Therapy ◽

Univariate Analysis ◽

Diabetic Patients ◽

Nihss Score ◽

Poor Outcome

Object The authors evaluated the prognostic significance of blood glucose level at admission (BGA) and change in blood glucose at 48 hours from the baseline value (CG48) in nondiabetic and diabetic patients before and after endovascular therapy for acute ischemic stroke (AIS). Methods The BGA and CG48 data were analyzed in 614 patients with AIS who received endovascular therapy at 7 US centers between 2006 and 2009. Data reviewed included demographics, stroke risk factors, diabetic status, National Institutes of Health Stroke Scale (NIHSS) score at presentation, recanalization grade, intracranial hemorrhage (ICH) rate, and 90-day outcomes (mortality rate and modified Rankin Scale score of 3–6 [defined as poor outcome]). Variables with p values < 0.2 in univariate analysis were included in a binary logistic regression model for independent predictors of 90-day outcomes. Results The mean patient age was 67.3 years, the median NIHSS score was 16, and 27% of patients had diabetes. In nondiabetic patients, BGA ≥ 116 mg/dl (≥ 6.4 mmol/L) and failure of glucose level to drop > 30 mg/dl (> 1.7 mmol/L) from the admission value were both significant predictors of 90-day poor outcome and death (p < 0.001). In patients with diabetes, BGA ≥ 116 mg/dl (≥ 6.4 mmol/L) was an independent predictor of poor outcome (p = 0.001). The CG48 was not a predictor of outcome in diabetic patients. A simplified 6-point scale including BGA, Thrombolysis in Myocardial Infarction (TIMI) Grade 2–3 Reperfusion, Age, presentation NIHSS score, CG48, and symptomatic ICH (BRANCH) corresponded with poor outcomes at 90 days; the area under the curve value was > 0.79. Conclusions Failure of blood glucose values to decrease in the first 48 hours after AIS intervention correlated with poor 90-day outcomes in nondiabetic patients. The BRANCH scale shows promise as a simple prognostication tool after endovascular therapy for AIS, and it merits prospective validation.

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Abstract WP17: Association of Blood Glucose and Clinical Outcome After Mechanical Thrombectomy for Acute Ischemic Stroke

Stroke ◽

10.1161/str.48.suppl_1.wp17 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Weston R Gordon ◽

Anit Behera ◽

John Chibnall ◽

Amer Alshekhlee ◽

Richard C Callison ◽

...

Keyword(s):

Ischemic Stroke ◽

Blood Glucose ◽

Clinical Outcome ◽

Hospital Stay ◽

Acute Ischemic Stroke ◽

Mechanical Thrombectomy ◽

Univariate Analysis ◽

Favorable Outcome ◽

Favorable Clinical Outcome ◽

Serial Measurements

Background: Elevated blood glucose (BG) levels at admission following acute ischemic stroke (AIS) have been associated with adverse clinical outcomes in thrombolytic and non-thrombolytic treated patients. This association has been inconsistent and has not been studied after mechanical thrombectomy (MT). The current study looks at multiple BG parameters and their association with outcome following MT in AIS. Methods: AIS patients undergoing MT with a retrievable stent between 2012 and 2016 at two stroke centers were studied. Favorable clinical outcome was defined as having a modified Rankin Scale score (mRS) of 0-2 at three months. Admission BG, maximum BG during the hospital stay, and serial measurements every 4-6 hours in the first 24 hours were recorded. The following demographic and clinical data was also collected: age, sex, baseline NIHSS score, onset-to-reperfusion times, HgA1c, and stroke mechanism. Results: Seventy-nine patients were identified (mean age 69, 49% male, SEM= 1.56); thirty-three patients had a favorable clinical outcome at three months and 46 had unfavorable outcomes. In univariate analysis, BG variability (standard deviation of BG, SD) in the first 24 hours following admission and maximum BG during hospital stay was associated with unfavorable outcomes (Table 1). The association between admission BG and favorable outcome was not statistically significant. In multivariate logistic regression analysis the SD of BG (OR= 1.08, 95% CI= 1.02-1.13, P= .005) had the highest predictive value for favorable outcome. Conclusions: Greater BG variability is associated with worse clinical outcome in patients with AIS undergoing MT. Using SD and/or serial measurements of BG appear better than single BG measurements at predicting clinical outcome in this population.

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Abstract TP317: Hyperglycemia Strongly Predicts Large Ischemic Infarct Growth Despite Full Endovascular Reperfusion

Stroke ◽

10.1161/str.48.suppl_1.tp317 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Mersedeh Bahr Hosseini ◽

Graham W Woolf ◽

Jason D Hinman ◽

Radoslav Raychev ◽

Latisha K Latisha K Sharma ◽

...

Keyword(s):

Ischemic Stroke ◽

Blood Glucose ◽

Blood Glucose Level ◽

Acute Ischemic Stroke ◽

Glucose Level ◽

Large Vessel ◽

Large Vessel Occlusion ◽

Vessel Occlusion ◽

Early Reperfusion ◽

Ischemic Infarct

Introduction: Ischemic infarct core grows at variable rates despite early reperfusion. The purpose of this study was to determine the predictors of infarct growth despite full recanalization of a large vessel occlusion in acute ischemic stroke. Method: Patients with acute ischemic stroke due to ICA or MCA occlusion who received endovascular therapy with Thrombolysis in Cerebral Infarction scale (TICI) scores of 2b or greater were subsequently selected between July 2012 and May 2016. The Alberta Stroke Program Early CT Score (ASPECT) was measured on the initial CT or MRI upon arrival and subsequently on the 24-hour scan. The infarct growth (delta d) was measured as initial ASPECT minus 24-hour ASPECT. Large and small infarct growth was defined as delta d of >= to3 and < 3 respectively. The relationship between the infarct growth and baseline variables of blood glucose level(BG), time of symptoms onset to recanalization time and baseline ASPECT score were assessed using statistical analysis. Results: Total of 76 patients were included. 32% had large infarct growth (25/76). The initial ASPECT score was not significantly different between the the 2 subgroups of large and small delta d (7.5 vs 6, P= 0.97). Baseline BG level was significantly higher in the group with larger infarct growth (160 vs 128, P=0.006). The baseline BG level of more than 150 was found as the threshold between the 2 subgroups (P=0.0003). No association was found between the infarct growth and history of diabetes (P= 0.7). Conclusion: Our data suggests that infarct growth occurs in relatively high percentage of ischemic stroke patients despite early full reperfusion of the large vessel occlusion. We showed that baseline blood glucose level particularly levels of higher than 150 is significantly associated with larger infarct growth. Therefore, it can be used as a strong predictive value in early recognition of this patient population.

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Initial factors affecting the clinical outcome after successful recanalization via MR-based mechanical thrombectomy in patients with acute ischemic stroke due to basilar artery occlusion

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2015-011912 ◽

2015 ◽

Vol 8 (9) ◽

pp. 889-893 ◽

Cited By ~ 7

Author(s):

Seungnam Son ◽

Yong-Won Kim ◽

Min Kyun Oh ◽

Soo-Kyoung Kim ◽

Ki-Jong Park ◽

...

Keyword(s):

Ischemic Stroke ◽

Clinical Outcome ◽

Acute Ischemic Stroke ◽

Basilar Artery ◽

Mechanical Thrombectomy ◽

Artery Occlusion ◽

Basilar Artery Occlusion ◽

Nihss Score ◽

Diffusion Weighted Images ◽

Outcome Group

Background and purposeTo determine the initial factors, including patient characteristics, stroke etiology and severity, time factors, and imaging findings, that could affect the clinical outcome of patients with acute ischemic stroke (AIS) caused by basilar artery occlusion (BAO) where successful recanalization was achieved via mechanical thrombectomy.MethodsBetween March 2011 and December 2014, 35 patients with AIS caused by BAO received MRI/MR angiography-based mechanical thrombectomies, and recanalization was achieved with a Thrombolysis In Cerebral Infarction score of >2b. The patients were divided into a good outcome group (n=19), defined as those with a modified Rankin Scale (mRS) score of 0–2 at 3 months after stroke onset, and a poor outcome group (n=16), defined as a mRS score of 3–6. The differences between the groups were analyzed.ResultsInitial National Institutes of Health Stroke Scale (NIHSS) score (good vs poor: 17.9±8.9 vs 27.6±8.5, p=0.003), posterior circulation Acute Stroke Prognosis Early CT Score (pc-ASPECTS) based on initial diffusion-weighted images (DWI) (good vs poor: 7.8±1.6 vs 5.4±1.8, p=0.001), pc-ASPECTS based on contrast staining on the post-thrombectomy control CT (good vs poor: 9.2±1.5 vs 6.3±2.2, p<0.001), and presence of contrast staining in the brainstem on that CT (good vs poor: 15.8% vs 81.6%, p<0.001) were significantly different between the groups.ConclusionsPatients with AIS caused by BAO with a lower initial NIHSS score, fewer lesions on initial DWI, and less contrast staining on the post-thrombectomy control CT have higher probabilities of a good clinical outcome after successful recanalization via a mechanical thrombectomy.

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Investigation of the role of sleep quality and sleep duration on fasting blood glucose level in acute ischemic stroke patients: A preliminary study

Narra J ◽

10.52225/narra.v1i3.59 ◽

2021 ◽

Vol 1 (3) ◽

Author(s):

Riza P. Putra ◽

Wardah R. Islamiyah

Keyword(s):

Ischemic Stroke ◽

Blood Glucose ◽

Sleep Quality ◽

Blood Glucose Level ◽

Acute Ischemic Stroke ◽

Sleep Duration ◽

Glucose Level ◽

Fasting Blood Glucose ◽

Fasting Blood Glucose Level ◽

Stroke Patients

The aim of this study was to evaluate the association between the sleep quality and sleep duration with the level of fasting blood glucose in patients with acute ischemic stroke. A cross-sectional study was conducted among acute ischemic stroke patients admitted to Dr. Soetomo Hospital and Universitas Airlangga Hospital from May to October 2021. Patients who met the inclusion were enrolled. To assess the sleep quality, Pittsburgh Sleeps Quality Index (PSQI) was applied. To determine sleep duration during the nocturnal period, Fitbit Charge 2 HR device was used. Evaluation of plausible confounders was assessed through physical examination, interviews, and a set of validated questionnaires. A total of 30 acute ischemic stroke patients were included in this study. The mean age of the participants was 56.40±9.77 years and 60% were males. There were 63.3% patients classified as mild stroke and 36.7% moderate-severe stroke. The average PQSI score was 5.57±2.59, while the average sleep duration was 319.8±108.7 minutes. The average fasting blood glucose level was 89.03±14.71 mg/dL. Significant positive correlation was obtained between sleep duration and fasting blood glucose level (r=0.533; p=0.002). Similarly, there was no statistically significant correlation between sleep quality with the level of fasting blood glucose (r=-0.167; p=0.377). To the best of our knowledge, this is the first study assessing the correlation between sleep quality and sleep duration with the level of fasting blood glucose levels in patients with acute ischemic stroke. This study therefore might be of great interest to provide insights on the importance of sleep management in acute ischemic stroke patients.

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Mechanical thrombectomy using a Solitaire stent retriever in the treatment of pediatric acute ischemic stroke

Journal of Neurosurgery Pediatrics ◽

10.3171/2018.9.peds18242 ◽

2019 ◽

Vol 23 (3) ◽

pp. 363-368 ◽

Cited By ~ 1

Author(s):

Bing Zhou ◽

Xiao-Chuan Wang ◽

Jun-Yi Xiang ◽

Ming-Zhao Zhang ◽

Bo Li ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Mechanical Thrombectomy ◽

Balloon Dilation ◽

Stent Retriever ◽

National Institutes Of Health ◽

Clinical Prognosis ◽

Nihss Score ◽

Grade 3

OBJECTIVEMechanical thrombectomy using a Solitaire stent retriever has been widely applied as a safe and effective method in adult acute ischemic stroke (AIS). However, due to the lack of data, the safety and effectiveness of mechanical thrombectomy using a Solitaire stent in pediatric AIS has not yet been verified. The purpose of this study was to explore the safety and effectiveness of mechanical thrombectomy using a Solitaire stent retriever for pediatric AIS.METHODSBetween January 2012 and December 2017, 7 cases of pediatric AIS were treated via mechanical thrombectomy using a Solitaire stent retriever. The clinical practice, imaging, and follow-up results were reviewed, and the data were summarized and analyzed.RESULTSThe ages of the 7 patients ranged from 7 to 14 years with an average age of 11.1 years. The preoperative National Institutes of Health Stroke Scale (NIHSS) scores ranged from 9 to 22 with an average of 15.4 points. A Solitaire stent retriever was used in all patients, averaging 1.7 applications of thrombectomy and combined balloon dilation in 2 cases. Grade 3 on the modified Thrombolysis In Cerebral Infarction scale of recanalization was achieved in 5 cases and grade 2b in 2 cases. Six patients improved and 1 patient died after thrombectomy. The average NIHSS score of the 6 cases was 3.67 at discharge. The average modified Rankin Scale score was 1 at the 3-month follow-up. Subarachnoid hemorrhage after thrombectomy occurred in 1 case and that patient died 3 days postoperatively.CONCLUSIONSThis study shows that mechanical thrombectomy using a Solitaire stent retriever has a high recanalization rate and excellent clinical prognosis in pediatric AIS. The safety of mechanical thrombectomy in pediatric AIS requires more clinical trials for confirmation.

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Efficacy of Mechanical Thrombectomy using Penumbra ACETM Aspiration Catheter Compared to Stent Retriever SolitaireTM FR in Patients with Acute Ischemic Stroke

Brain Sciences ◽

10.3390/brainsci11040504 ◽

2021 ◽

Vol 11 (4) ◽

pp. 504

Author(s):

Dalibor Sila ◽

Markus Lenski ◽

Maria Vojtková ◽

Mustafa Elgharbawy ◽

František Charvát ◽

...

Keyword(s):

Ischemic Stroke ◽

Clinical Outcome ◽

Acute Ischemic Stroke ◽

Clinical Outcomes ◽

Mechanical Thrombectomy ◽

Binary Logistic Regression ◽

Stent Retriever ◽

Good Clinical Outcome ◽

Significant Difference ◽

Aspiration Technique

Background: Mechanical thrombectomy is the standard therapy in patients with acute ischemic stroke (AIS). The primary aim of our study was to compare the procedural efficacy of the direct aspiration technique, using Penumbra ACETM aspiration catheter, and the stent retriever technique, with a SolitaireTM FR stent. Secondarily, we investigated treatment-dependent and treatment-independent factors that predict a good clinical outcome. Methods: We analyzed our series of mechanical thrombectomies using a SolitaireTM FR stent and a Penumbra ACETM catheter. The clinical and radiographic data of 76 patients were retrospectively reviewed. Using binary logistic regression, we looked for the predictors of a good clinical outcome. Results: In the Penumbra ACETM group we achieved significantly higher rates of complete vessel recanalization with lower device passage counts, shorter recanalization times, shorter procedure times and shorter fluoroscopy times (p < 0.001) compared to the SolitaireTM FR group. We observed no significant difference in good clinical outcomes (52.4% vs. 56.4%, p = 0.756). Predictors of a good clinical outcome were lower initial NIHSS scores, pial arterial collateralization on admission head CT angiography scan, shorter recanalization times and device passage counts. Conclusions: The aspiration technique using Penumbra ACETM catheter is comparable to the stent retriever technique with SolitaireTM FR regarding clinical outcomes.

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Nutritional Therapy In Ischemic Stroke Patients With Type 2 Diabetes Mellitus : A Case Report

Smart Medical Journal ◽

10.13057/smj.v3i1.42114 ◽

2020 ◽

Vol 3 (1) ◽

pp. 33

Author(s):

Cipuk Muhaswitri ◽

Diyah Eka Andayani ◽

Taufik Mesiano

Keyword(s):

Diabetes Mellitus ◽

Ischemic Stroke ◽

Blood Glucose ◽

Blood Glucose Level ◽

Glucose Level ◽

Nutritional Therapy ◽

Facial Nerve Paralysis ◽

Stroke Patients ◽

Nerve Paralysis

Introduction: The prevalence of stroke in Indonesia increased from 8.3 per 1000 population in 2007 to 12.1 per 1000 population in 2013, based on Riset Kesehatan Dasar (RISKESDAS) 2013. Diabetes mellitus (DM) is an independent risk factor and can be modified. Hyperglycemia that occurs in the acute phase of stroke is associated with an increase in mortality and poor clinical outcome after stroke. Moreover, stroke patients are at risk of developing hypoalbuminemia due to poor intake and the presence of a chronic inflammatory process. Methods: A 66-year-old female patient with third recurrent ischemic stroke, history of uncontrolled DM, conciousness based on GCS is E3M5Vaphasia, Nasogastric tube (NGT) was inserted and there was a right facial nerve paralysis and bilateral hemiparesis . Nutritional status of patient is obese-1. During follow up period, the patient's blood glucose level ranged from 194 g/dl-345 g/dl. Nutrition therapy is given with a target of 1350 kcal (32 kcal/kg). Its composition consists of 15% protein, 25% fat and 60% carbohydrate (preferred complex carbohydrates), in the form of DM-specific formula containing inulin and monounsaturated fatty acid (MUFA). This nutritional therapy was administrated six times per day via enteral pathway, followed by the administration of micronutrients of vitamins C, B and folic acid. Result: During follow up period, the patient tolerated well with the diet. After the 14 days hospitalization, there was improvement of blood glucose level (<200 g/dL). Albumin level increases from 2.5 g/dL to 2.9 g/dl by the nutritional therapy containing protein more than 1.2 g/kg/day. Conclusion: Administering a diet with the recommended composition and formula helps control hyperglycemia and improve hypoalbuminemia in patients that can improve the patient's clinical condition.

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EFFECTIVENESS OF AMLA JUICE IN REDUCING BLOOD GLUCOSE LEVEL AMONG PATIENTS WITH TYPE II DIABETES IN A SELECTED AREA OF KANYAKUMARI DISTRICT

THE RESEARCH RESERVOIR ◽

10.47211/trr.2021.v07i01.012 ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

Mrs. Vanitha. S s ◽

Dr. Pramjit kaur

Keyword(s):

Blood Glucose ◽

Standard Deviation ◽

Blood Glucose Level ◽

Glucose Level ◽

Type Ii Diabetes ◽

Control Group ◽

Type Ii ◽

Glucose Levels ◽

Blood Glucose Levels ◽

Experimental Group

Challenges in lifestyle, such as increasesin energy intake and decreasesin physical activity are causing overweight and obesity leading to epidemic increases in type II Diabetes Mellitus. The research approach used for this study was evaluative approach and the research design was true experimental design. 60 patients with type II diabetes, 30 in experimental group and 30 in control group were selected for this study by using purposive sampling technique. Data was collected with the help of self-structured interview schedule. Descriptive statistics (frequency, percentage, mean and standard deviation) and inferential statistics (chi-square, paired ‘t’ test) were used to analyse the data and to test the hypotheses. In the experimental group,the pre-test mean score was 2.966, mean percentage was 59% and standard deviation was 1.129 and in post-testmean score was 2.533, mean percentage was 50.66% and standard deviation was 1.074 with effectiveness of 8.34% and paired‘t’ test value of t=3.971,which was statistically significant (p<0.05) which is an evidence ofthe effectiveness of Amla juice in reducing blood glucose level. Comparison of blood glucose levels in experimental and control groups, shows that the value is statistically highly significant, as was observed from the unpaired ‘t’ test value of 13.39 with P value of <0.05, which is an evidence indicatingthe effect of Amla juice in reducing postprandial blood glucose levels. The resultsfound that the administration of Amla juice did have aneffect in reducing blood glucose level in the experimental group. By comparing the findings of pre-test and post test between the experimental group and the control group,the effect was identified (assessed). The study concluded that the Amlajuice is effective in reducing blood glucose level.

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Abstract TMP6: A Multi-center Study of Safety and Efficacy of Mechanical Thrombectomy for Acute Ischemic Stroke Patients with Emergent Large Vessel Occlusions Not Meeting Top Tier Evidence Criteria

Stroke ◽

10.1161/str.48.suppl_1.tmp6 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Nitin Goyal ◽

Georgios Tsivgoulis ◽

Donald Frei ◽

Aquilla Turk ◽

Blaise Baxter ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Mechanical Thrombectomy ◽

Interquartile Range ◽

Large Vessel ◽

Safety And Efficacy ◽

Nihss Score ◽

Multi Center Study ◽

Center Study ◽

Median Admission

Background: Recent recommendations for mechanical thrombectomy (MT) of acute ischemic stroke (AIS) patients with emergent large-vessel occlusions (ELVO) appropriately award top tier evidence (TTE) to the same selective criteria that were employed in recent clinical trials. We sought to evaluate the safety and efficacy of MT in AIS patients with ELVO who fail TTE criteria in a prospective multi-center study. Methods: Data on consecutive AIS patients with ELVO who underwent mechanical thrombectomy were collected from 6 high-volume endovascular centers. Standard safety and efficacy outcomes were compared between patients meeting and failing TTE criteria. Results: TTE criteria for MT were fulfilled in 349 (60%) cases (mean age 63±18 years; 47% men; median admission NIHSS-score 17 points, interquartile range 14-21), whereas 234 (40%) patients did not meet TTE criteria (mean age 62±19 years; 53% men; median admission NIHSS-score 16 points, interquartile range 9-21). (Table 1) The two most common reasons for failing TTE criteria were location of intracranial occlusion (n=144) and treatment window (n=108). In multivariate logistic regression models adjusting for potential confounders cases failing TTE criteria had similar safety (three-month mortality and symptomatic intracranial hemorrhage) and efficacy (three-month functional independence) outcomes with patients meeting TTE. Location of occlusion and proposed time-window according to TTE was also not related to any safety or efficacy outcome. (Table 2) Conclusions: Approximately 40% of AIS patients with ELVO offered MT do not fulfill TTE criteria for MT. Our multi-center experience indicates that MT may be offered to these patients with similar safety and efficacy to ELVO cases meeting TTE. Evidence-based medicine requires that health care providers understand published data and how those data might apply to a given patient’s treatment options. In a changing treatment environment this is a dynamic process.

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