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(Stroke. 2001;32:2318.)
© 2001 American Heart Association, Inc.

Original Contributions

Heterogeneity Affecting Outcome From Acute Stroke Therapy

Making Reperfusion Worse

Thomas A. Kent, MD; Vicki M. Soukup, PhD Roderic H. Fabian, MD

From the Departments of Neurology (T.A.K., V.M.S., R.H.F.), Pharmacology (T.A.K.), Anatomy and Neurosciences (R.H.F.), and the Marine Biomedical Institute (T.A.K., R.H.F.), University of Texas Medical Branch, Galveston, Tex.

Correspondence to Thomas A. Kent, MD, Department of Neurology, Room 9.128 JSA, The University of Texas Medical Branch, Galveston, TX 77555. E-mail thomas.kent{at}utmb.edu

Background—— Stroke patients are heterogeneous not only with respect to etiology but also in terms of preexisting clinical conditions. Approximately one fifth of patients with acute stroke are hyperglycemic and/or have had a recent infectious or inflammatory condition.

Summary of Review—— Experimental research indicates that these factors can alter and accelerate the evolution of stroke and reperfusion injury, although these effects are complex and some may have a favorable impact. Both conditions involve activation of inflammatory and reactive oxygen mechanisms. In addition, hyperglycemia has concomitant deleterious vascular and metabolic effects that worsen infarct size and encourage hemorrhagic transformation in reperfusion models. Clinical data are less extensive but in general support an adverse impact on outcome.

Conclusions—— After examining these data in detail, we concluded that the presence of these clinical conditions could assist in identification of those at increased risk for complications of reperfusion therapy. Furthermore, consideration of these factors may provide a rational basis for combination therapy and improve the clinical relevance of experimental stroke models.

Key Words: cytokines • hyperglycemia • reperfusion injury • stroke • tissue plasminogen activator

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