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

Abstract 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...

Descripción completa

Guardado en:

Detalles Bibliográficos
Autores principales:	Carlos Laredo, Arturo Renú, Laura Llull, Raúl Tudela, Antonio López-Rueda, Xabier Urra, Napoleón G. Macías, Salvatore Rudilosso, Víctor Obach, Sergio Amaro, Ángel Chamorro
Formato:	article
Lenguaje:	EN
Publicado:	Nature Portfolio 2020
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/815728de065f4259ab70860e97728f59
Etiquetas:	Agregar Etiqueta Sin Etiquetas, Sea el primero en etiquetar este registro!

id	oai:doaj.org-article:815728de065f4259ab70860e97728f59
record_format	dspace
spelling	oai:doaj.org-article:815728de065f4259ab70860e97728f592021-12-02T16:31:42ZElevated glucose is associated with hemorrhagic transformation after mechanical thrombectomy in acute ischemic stroke patients with severe pretreatment hypoperfusion10.1038/s41598-020-67448-x2045-2322https://doaj.org/article/815728de065f4259ab70860e97728f592020-06-01T00:00:00Zhttps://doi.org/10.1038/s41598-020-67448-xhttps://doaj.org/toc/2045-2322Abstract 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.Carlos LaredoArturo RenúLaura LlullRaúl TudelaAntonio López-RuedaXabier UrraNapoleón G. MacíasSalvatore RudilossoVíctor ObachSergio AmaroÁngel ChamorroNature PortfolioarticleMedicineRScienceQENScientific Reports, Vol 10, Iss 1, Pp 1-9 (2020)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Carlos Laredo Arturo Renú Laura Llull Raúl Tudela Antonio López-Rueda Xabier Urra Napoleón G. Macías Salvatore Rudilosso Víctor Obach Sergio Amaro Ángel Chamorro Elevated glucose is associated with hemorrhagic transformation after mechanical thrombectomy in acute ischemic stroke patients with severe pretreatment hypoperfusion
description	Abstract 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.
format	article
author	Carlos Laredo Arturo Renú Laura Llull Raúl Tudela Antonio López-Rueda Xabier Urra Napoleón G. Macías Salvatore Rudilosso Víctor Obach Sergio Amaro Ángel Chamorro
author_facet	Carlos Laredo Arturo Renú Laura Llull Raúl Tudela Antonio López-Rueda Xabier Urra Napoleón G. Macías Salvatore Rudilosso Víctor Obach Sergio Amaro Ángel Chamorro
author_sort	Carlos Laredo
title	Elevated glucose is associated with hemorrhagic transformation after mechanical thrombectomy in acute ischemic stroke patients with severe pretreatment hypoperfusion
title_short	Elevated glucose is associated with hemorrhagic transformation after mechanical thrombectomy in acute ischemic stroke patients with severe pretreatment hypoperfusion
title_full	Elevated glucose is associated with hemorrhagic transformation after mechanical thrombectomy in acute ischemic stroke patients with severe pretreatment hypoperfusion
title_fullStr	Elevated glucose is associated with hemorrhagic transformation after mechanical thrombectomy in acute ischemic stroke patients with severe pretreatment hypoperfusion
title_full_unstemmed	Elevated glucose is associated with hemorrhagic transformation after mechanical thrombectomy in acute ischemic stroke patients with severe pretreatment hypoperfusion
title_sort	elevated glucose is associated with hemorrhagic transformation after mechanical thrombectomy in acute ischemic stroke patients with severe pretreatment hypoperfusion
publisher	Nature Portfolio
publishDate	2020
url	https://doaj.org/article/815728de065f4259ab70860e97728f59
work_keys_str_mv	AT carloslaredo elevatedglucoseisassociatedwithhemorrhagictransformationaftermechanicalthrombectomyinacuteischemicstrokepatientswithseverepretreatmenthypoperfusion AT arturorenu elevatedglucoseisassociatedwithhemorrhagictransformationaftermechanicalthrombectomyinacuteischemicstrokepatientswithseverepretreatmenthypoperfusion AT laurallull elevatedglucoseisassociatedwithhemorrhagictransformationaftermechanicalthrombectomyinacuteischemicstrokepatientswithseverepretreatmenthypoperfusion AT raultudela elevatedglucoseisassociatedwithhemorrhagictransformationaftermechanicalthrombectomyinacuteischemicstrokepatientswithseverepretreatmenthypoperfusion AT antoniolopezrueda elevatedglucoseisassociatedwithhemorrhagictransformationaftermechanicalthrombectomyinacuteischemicstrokepatientswithseverepretreatmenthypoperfusion AT xabierurra elevatedglucoseisassociatedwithhemorrhagictransformationaftermechanicalthrombectomyinacuteischemicstrokepatientswithseverepretreatmenthypoperfusion AT napoleongmacias elevatedglucoseisassociatedwithhemorrhagictransformationaftermechanicalthrombectomyinacuteischemicstrokepatientswithseverepretreatmenthypoperfusion AT salvatorerudilosso elevatedglucoseisassociatedwithhemorrhagictransformationaftermechanicalthrombectomyinacuteischemicstrokepatientswithseverepretreatmenthypoperfusion AT victorobach elevatedglucoseisassociatedwithhemorrhagictransformationaftermechanicalthrombectomyinacuteischemicstrokepatientswithseverepretreatmenthypoperfusion AT sergioamaro elevatedglucoseisassociatedwithhemorrhagictransformationaftermechanicalthrombectomyinacuteischemicstrokepatientswithseverepretreatmenthypoperfusion AT angelchamorro elevatedglucoseisassociatedwithhemorrhagictransformationaftermechanicalthrombectomyinacuteischemicstrokepatientswithseverepretreatmenthypoperfusion
_version_	1718383884909936640

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

Ejemplares similares