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(Stroke. 2003;34:1240.)
© 2003 American Heart Association, Inc.

Original Contributions

Editorial Comment—Hyperglycemia and Early Reperfusion Therapy

Stroke Unit, Department of Neurology, Sheba Medical Center, Tel-Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel

An extract of the first 250 words of the full text is provided, because this article has no abstract.

Clinical studies of acute ischemic stroke support the conclusions of most experimental studies of focal cerebral ischemia in suggesting that admission hyperglycemia is associated with a worse clinical outcome.¹ This association is more consistent in nonlacunar strokes² and in experimental models of reversible focal cerebral ischemia.³ The acute ischemic penumbra might be preferentially susceptible to injury in hyperglycemic ischemia. Indeed, by use of MR methods, hyperglycemia in acute ischemic stroke was shown to promote the evolution of hypoperfused tissue to infarction and to do so by increased brain lactate production.⁴

This role of hyperglycemia may be of particular importance in patients treated with early reperfusion therapy. Elevated admission blood glucose has emerged as a probable risk factor for thrombolysis-related ICH and for poor outcome in patients with acute ischemic stroke.^5–7 A recent post hoc analysis from the NINDS rtPA Stroke Trial has shown that in patients with acute ischemic stroke, higher admission glucose levels are associated with significantly lower odds for desirable clinical outcomes and significantly higher odds for symptomatic ICH, regardless of whether recombinant tPA (rtPA) treatment is given.⁸

In the accompanying article, Alvarez-Sabín et al demonstrate, in a case series of patients with acute ischemic stroke treated with rtPA and assessed serially by TCD, that admission hyperglycemia independently predicts poor outcome in reperfused but not in nonreperfused rtPA-treated patients. These intriguing findings suggest that the deleterious effect of hyperglycemia on infarct growth may be related to whether or not reperfusion occurs. While the study provides useful data that . . . [Full Text of this Article]