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

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) aft...

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Autores: Laredo Gregorio, Carlos, Renú, Arturo, Llull Estrany, Laura, Tudela Fernández, Raúl, López Rueda, Antonio, Urra, Xabier, Macías, Napoleón G., Rudilosso, Salvatore, Obach, Víctor, Amaro Delgado, Sergio, Chamorro Sánchez, Ángel
Formato: artículo
Estado:Versión publicada
Fecha de publicación:2020
País:España
Recursos:Varias* (Consorci de Biblioteques Universitáries de Catalunya, Centre de Serveis Científics i Acadèmics de Catalunya)
Repositorio:Recercat. Dipósit de la Recerca de Catalunya
OAI Identifier:oai:recercat.cat:2445/168357
Acesso em linha:https://hdl.handle.net/2445/168357
Access Level:acceso abierto
Palavra-chave:Embòlia i trombosi cerebral
Isquèmia cerebral
Glucèmia
Tomografia
Imatges per ressonància magnètica
Cerebral embolism and thrombosis
Cerebral ischemia
Blood sugar
Tomography
Magnetic resonance imaging
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oai_identifier_str oai:recercat.cat:2445/168357
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spelling Elevated glucose is associated with hemorrhagic transformation after mechanical thrombectomy in acute ischemic stroke patients with severe pretreatment hypoperfusionLaredo Gregorio, CarlosRenú, ArturoLlull Estrany, LauraTudela Fernández, RaúlLópez Rueda, AntonioUrra, XabierMacías, Napoleón G.Rudilosso, SalvatoreObach, VíctorAmaro Delgado, SergioChamorro Sánchez, ÁngelEmbòlia i trombosi cerebralIsquèmia cerebralGlucèmiaTomografiaImatges per ressonància magnèticaCerebral embolism and thrombosisCerebral ischemiaBlood sugarTomographyMagnetic resonance imagingSeveral 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.Nature Publishing Group2020202020202020info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersion9 p.application/pdfhttps://hdl.handle.net/2445/168357Articles publicats en revistes (Cirurgia i Especialitats Medicoquirúrgiques)reponame:Recercat. Dipósit de la Recerca de Catalunyainstname:Varias* (Consorci de Biblioteques Universitáries de Catalunya, Centre de Serveis Científics i Acadèmics de Catalunya)InglésReproducció del document publicat a: https://doi.org/10.1038/s41598-020-67448-xScientific Reports, 2020, vol. 10, num. 10588https://doi.org/10.1038/s41598-020-67448-xcc-by (c) Laredo, Carlos et al., 2020http://creativecommons.org/licenses/by/3.0/esinfo:eu-repo/semantics/openAccessoai:recercat.cat:2445/1683572026-05-29T05:05:01Z
dc.title.none.fl_str_mv Elevated glucose is associated with hemorrhagic transformation after mechanical thrombectomy in acute ischemic stroke patients with severe pretreatment hypoperfusion
title Elevated glucose is associated with hemorrhagic transformation after mechanical thrombectomy in acute ischemic stroke patients with severe pretreatment hypoperfusion
spellingShingle Elevated glucose is associated with hemorrhagic transformation after mechanical thrombectomy in acute ischemic stroke patients with severe pretreatment hypoperfusion
Laredo Gregorio, Carlos
Embòlia i trombosi cerebral
Isquèmia cerebral
Glucèmia
Tomografia
Imatges per ressonància magnètica
Cerebral embolism and thrombosis
Cerebral ischemia
Blood sugar
Tomography
Magnetic resonance imaging
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
dc.creator.none.fl_str_mv Laredo Gregorio, Carlos
Renú, Arturo
Llull Estrany, Laura
Tudela Fernández, Raúl
López Rueda, Antonio
Urra, Xabier
Macías, Napoleón G.
Rudilosso, Salvatore
Obach, Víctor
Amaro Delgado, Sergio
Chamorro Sánchez, Ángel
author Laredo Gregorio, Carlos
author_facet Laredo Gregorio, Carlos
Renú, Arturo
Llull Estrany, Laura
Tudela Fernández, Raúl
López Rueda, Antonio
Urra, Xabier
Macías, Napoleón G.
Rudilosso, Salvatore
Obach, Víctor
Amaro Delgado, Sergio
Chamorro Sánchez, Ángel
author_role author
author2 Renú, Arturo
Llull Estrany, Laura
Tudela Fernández, Raúl
López Rueda, Antonio
Urra, Xabier
Macías, Napoleón G.
Rudilosso, Salvatore
Obach, Víctor
Amaro Delgado, Sergio
Chamorro Sánchez, Ángel
author2_role author
author
author
author
author
author
author
author
author
author
dc.subject.none.fl_str_mv Embòlia i trombosi cerebral
Isquèmia cerebral
Glucèmia
Tomografia
Imatges per ressonància magnètica
Cerebral embolism and thrombosis
Cerebral ischemia
Blood sugar
Tomography
Magnetic resonance imaging
topic Embòlia i trombosi cerebral
Isquèmia cerebral
Glucèmia
Tomografia
Imatges per ressonància magnètica
Cerebral embolism and thrombosis
Cerebral ischemia
Blood sugar
Tomography
Magnetic resonance imaging
description 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.
publishDate 2020
dc.date.none.fl_str_mv 2020
2020
2020
2020
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv https://hdl.handle.net/2445/168357
url https://hdl.handle.net/2445/168357
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.relation.none.fl_str_mv Reproducció del document publicat a: https://doi.org/10.1038/s41598-020-67448-x
Scientific Reports, 2020, vol. 10, num. 10588
https://doi.org/10.1038/s41598-020-67448-x
dc.rights.none.fl_str_mv cc-by (c) Laredo, Carlos et al., 2020
http://creativecommons.org/licenses/by/3.0/es
info:eu-repo/semantics/openAccess
rights_invalid_str_mv cc-by (c) Laredo, Carlos et al., 2020
http://creativecommons.org/licenses/by/3.0/es
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv 9 p.
application/pdf
dc.publisher.none.fl_str_mv Nature Publishing Group
publisher.none.fl_str_mv Nature Publishing Group
dc.source.none.fl_str_mv Articles publicats en revistes (Cirurgia i Especialitats Medicoquirúrgiques)
reponame:Recercat. Dipósit de la Recerca de Catalunya
instname:Varias* (Consorci de Biblioteques Universitáries de Catalunya, Centre de Serveis Científics i Acadèmics de Catalunya)
instname_str Varias* (Consorci de Biblioteques Universitáries de Catalunya, Centre de Serveis Científics i Acadèmics de Catalunya)
reponame_str Recercat. Dipósit de la Recerca de Catalunya
collection Recercat. Dipósit de la Recerca de Catalunya
repository.name.fl_str_mv
repository.mail.fl_str_mv
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score 15.812429

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