Lina Palaiodimou, MD
Hyperglycemia upon admission is a common phenomenon in acute ischemic stroke and is an independent predictor of poor outcome in both diabetic and non-diabetic stroke patients. More specifically, previous studies have shown that hyperglycemia is independently associated with infarct expansion, early hemorrhagic transformation, impaired recanalization and increased rates of symptomatic intracranial hemorrhage after intravenous thrombolysis. Increased admission and fasting glucose are associated with unfavorable short-term outcome in patients with large vessel occlusion treated with endovascular reperfusion therapies, especially in the subgroup of patients not achieving complete reperfusion following mechanical thrombectomy. However, aggressive serum glucose lowering in clinical studies failed to translate into improvements in functional outcomes, indicating heterogeneity of the biological effects of glucose and the different ways that can modify prognosis in different clinical settings. Accordingly, case-specific glucose management appears to be important.
Κim et al. conducted a post-hoc analysis using data from the Triple-S database, in order to explore the potential association between poor collaterals at presentation and hyperglycemia and the interaction between pretreatment collaterals and glucose upon admission on outcomes. They obtained data from 3 prospective clinical trials (SWIFT, SWIFT PRIME and STAR) and included 309 patients who had acute ischemic stroke with moderate to severe neurological deficit and angiographically confirmed large vessel occlusion and were treated with mechanical thrombectomy within 8 hours of onset. Pretreatment collaterals grades were scored according to the American Society of Interventional and Therapeutic Neuroradiology collateral grading (AGC) system, and reperfusion was evaluated using modified TICI score.