Symptomatic intracranial hemorrhage in patients with admission hyperglycemia and diabetes after mechanical thrombectomy: A systematic review and meta-analysis

Zang, Lin; Zhang, Dan; Yao, Y.L.; Wang, Yujie

doi:10.1016/j.ajem.2021.02.032

Cited by 17 publications

(12 citation statements)

References 31 publications

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“…Our study on TO demonstrate the same association between increased sICH risk and multiple retriever passes. Diabetes as a predictor for sICH in this study are in accordance with earlier studies reporting higher rates of hemorrhagic transformation or worse outcome in patients with diabetes mellitus in SO, though we did not find hyperglycemia to be associated with sICH as earlier reported [ 16 , 19 , 20 ].…”

Section: Discussionsupporting

confidence: 93%

Predictors of outcome after endovascular treatment for tandem occlusions: a single center retrospective analysis

Enriquez

Nome

et al. 2023

BMC Neurol

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Background The endovascular treatment procedure in tandem occlusions (TO) is complex compared to single occlusion (SO) and optimal management remains uncertain. The aim of this study was to identify clinical and procedural factors that may be associated to efficacy and safety in the management of TO and compare functional outcome in TO and SO stroke patients. Methods This is a retrospective single center study of medium (MeVO) and large vessel occlusion (LVO) of the anterior circulation. Clinical, imaging, and interventional data were analyzed to identify predictive factors for symptomatic intracranial hemorrhage (sICH) and functional outcome after endovascular treatment (EVT) in TO. Functional outcome in TO and SO patients was compared. Results Of 662 anterior circulation stroke patients with MeVO and LVO stroke, 90 (14%) had TO. Stenting was performed in 73 (81%) of TO patients. Stent thromboses occurred in 8 (11%) patients. Successful reperfusion with modified thrombolysis in cerebral infarction (mTICI) ≥ 2b was achieved in 82 (91%). SICH occurred in seven (8%). The strongest predictors for sICH were diabetes mellitus and number of stent retriever passes. Good functional clinical outcome (mRS ≤ 2) at 90-day follow up was similar in TO and SO patients (58% vs 59% respectively). General anesthesia (GA) was associated with good functional outcome whereas hemorrhage in the infarcted tissue, lower mTICI score and history of smoking were associated with poor outcome. Conclusions The risk of sICH was increased in patients with diabetes mellitus and those with extra stent-retriever attempts. Functional clinical outcomes in patients with TO were comparable to patients with SO.

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Section: Discussionsupporting

confidence: 93%

Predictors of outcome after endovascular treatment for tandem occlusions: a single center retrospective analysis

Enriquez

Nome

et al. 2023

BMC Neurol

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“…According to data published previously, in stroke patients treated with MT the risk of intracranial haemorrhage is associated with some admission parameters, including hyperglycaemia, but not with a history of DM [37][38][39]. The cumulative outcome of the effect of the chronic influence of hyperglycaemia in DM and of the acute influence of MT on the endothelium may account for poorer outcomes in this patient group and for long-term follow-up results.…”

Section: Discussionmentioning

confidence: 81%

Relevance of admission hyperglycaemia and diabetes mellitus to efficacy and safety of mechanical thrombectomy in stroke patients

Lasek–Bal

Żak

Binek

et al. 2022

Neurol Neurochir Pol.

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Introduction. The relevance of diabetes mellitus (DM) to the efficacy of mechanical thrombectomy (MT) has been the subject of few studies and with only inconclusive results.Objectives. This study aimed to evaluate the effect of DM and admission hyperglycaemia on the efficacy and safety of MT in stroke patients. Material and methods.This retrospective study analysis focused on the relevance of admission hyperglyacemia and DM to the functional status of patients treated with MT at the Upper Silesian Medical Centre of the Silesian Medical University in Katowice, Poland.Results. 417 stroke patients (median age 70 years) were qualified for the study. There were 103 patients (24.70%) with DM. Admission hyperglycaemia ≥ 140 mg% was found in 91 patients (21.82%), of whom 69 were diagnosed with DM before or during hospitalisation. The parameters with the strongest effect on the functional status on days 7, 90 and 365 were: age, and neurological status according to the National Institutes of Health Stroke Scale (NIHSS) on the first day of ischaemic stroke before MT. The angiographic effect indirect after MT and patient functional status on days 7, 90 and 365 were comparable between the groups, regardless of the DM burden. The frequency of symptomatic intracranial bleeding 24 hours after MT was comparable between patients with and patients without DM (p = 0.092).Model based on parameters were age, NIHSS on the first day of ischaemic stroke, an when score in Thrombolysis In Cerebral Infarct (TICI) showed good predictive attributes for the functional status of patients in the acute period (day 7). Age, a lack of admission hyperglycaemia, and the neurological state on day 1 of ischaemic stroke (before MT) were the key parameters for a favourable outcome (≤ 2 points on the modified Rankin Scale, mRS) on day 90. Admission hyperglycaemia ≥ 140 mg/dL, regardless of the presence or absence of DM, had a negative effect on achieving a good functional status one week after stroke onset. Conclusions. Diabetes mellitus has a neutral effect on the angiographic and clinical outcomes of mechanical thrombectomy in stroke patients. It does not increase the risk of intracranial haemorrhage after instrumental therapy. It is admission hyperglycaemia, rather than diabetes mellitus, that is a predictor of poor functional status in patients treated with thrombectomy. According to our results, the patient's neurological status, age, and the outcome of thrombectomy are relevant to the functional status in the acute ischaemic stroke period.

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“…This suggests that women may have better clinical outcomes following EVT. Despite the fact that older patients have a worse prognosis than younger ones, age does not appear to be related to infarct growth or larger FIV after EVT [24,25]. This could modify the association between FIV and functional outcome, indicating a lesser FIV threshold for poor prognosis among older people [26].…”

Section: Follow-up Infarct Volumementioning

confidence: 93%

“…There is some data showing that several comorbidities and biochemical parameters affect the incidence of HT after MT treatment. A prior-to-stroke diagnosis of diabetes and higher admission blood glucose levels significantly elevate the risk of both HT and sICH [24,34,36]. Post-procedural hyperglycaemia was also found to be an independent risk factor of a latter haemorrhagic post-treatment complication [43].…”

Section: Haemorrhagic Transformationmentioning

confidence: 94%

Risk factors for infarct growth and haemorrhagic or oedematous complications after endovascular treatment — a literature review

Tomaszewska-Lampart

Wiącek²,

Bartosik-Psujek³

2022

Neurol Neurochir Pol.

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Introduction. Acute ischaemic stroke (AIS) is caused by significant disturbances in the cerebral bloodflow (CBF) that lead to brain ischaemia and eventually result in irreversible brain tissue damage. The main goal of its treatment is to restore bloodflow to the areas at risk of necrosis. Intravenous thrombolysis (IVT) and mechanical thrombectomy (MT) are the mainstay of current therapy, with the latter being widely employed in selected patients with radiologically proven large vessel occlusion (LVO). Despite convincing evidence of its efficacy, up to half of patients undergoing endovascular treatment (EVT) still do not achieve a beneficial functional outcome; this is mainly due to unfavourable brain tissue sequelae. Therefore, factors associated with known adverse brain changes, such as larger infarct size or haemorrhagic and oedematous complications, should be adequately addressed.Objective. To review the available literature describing AIS brain tissue outcome assessed by computed tomography (CT) and/ or magnetic resonance imaging (MRI) in patients undergoing MT treatment. Additionally, to evaluate the association of post-MT tissue changes with short-and long-term prognosis.Material and methods. We searched the PubMed, Scopus, EMBASE, and Google Scholar databases according to established criteria.Results. We found a total of 264 articles addressing the most common types of AIS tissue sequelae after EVT (i.e. MT with or without IVT as bridging therapy) by brain CT and MRI. These were: follow-up infarct volume (FIV), cerebral oedema (COD) and haemorrhagic transformation (HT). As the next step, 37 articles evaluating factors associated with defined outcomes were selected. Several non-modifiable factors such as age, comorbidities, pretreatment neurological deficit, and collateral circulation status were found to affect stroke tissue sequelae, to varying degrees. Additionally, some factors including time to treatment initiation, selection of treatment device, and periprocedural systemic blood pressure, the modification of which can potentially reduce the occurrence of an unfavourable tissue outcome, were identified. Some recently revealed biochemical and serological parameters may play a similar role.Conclusions. The identification of factors that affect post-MT ischaemic area evolution may result in studies assessing the effects of their modification, and potentially improve clinical outcomes. Modifiable parameters, including periprocedural systemic blood pressure and some biochemical factors, may be of particular importance.

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Symptomatic intracranial hemorrhage in patients with admission hyperglycemia and diabetes after mechanical thrombectomy: A systematic review and meta-analysis

Cited by 17 publications

References 31 publications

Predictors of outcome after endovascular treatment for tandem occlusions: a single center retrospective analysis

Predictors of outcome after endovascular treatment for tandem occlusions: a single center retrospective analysis

Relevance of admission hyperglycaemia and diabetes mellitus to efficacy and safety of mechanical thrombectomy in stroke patients

Risk factors for infarct growth and haemorrhagic or oedematous complications after endovascular treatment — a literature review

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