Abstract 2458: Admission Hyperglycemia Causes Infarct Volume Expansion In Patients With ICA And MCA Occlusion: Association Of Collateral Grade On Cerebral Angiography.
Background: The collateral circulation sustains the ischemic penumbra to limit growth of infarct volume. Recent study showed hyperglycemia was associated with infarct volume expansion in acute ischemic stroke patients. The aim of present study is to investigate whether admission hyperglycemia is related with enlargement of infarct volume and poor outcome based on the collateral circulation grade.
Methods: From April 2004 to July 2011, acute ischemic stroke patients with ICA and MCA occlusion on cerebral angiography within 24 h of onset were retrospectively studied. We excluded the patients treated with iv t-PA or endovascular therapy. Hyperglycemia was defined as admitting blood glucose value>140mg/dl. Angiographic collateral was evaluated with the ASITN/SIR collateral flow grading system. Grade 0 to 1 was designated as poor collateral and grade 2 to 4 as good collateral. Infarct volume was measured on admission and follow-up (<7days after admission) diffusion weighted imaging on MRI. We compared Δinfarct volume (follow-up-baseline) and patient outcome between hyperglycemic (HG) group and non-HG group according to each collateral grade.
Results: 93 patients (65 males, 67.7±13.3 years old, ICA occlusion in 52 and MCA in 41 patients) were enrolled in the present study. Collateral grade was poor in 34 patients (36.6%) and good in 59 patients (63.4%).In poor collateral grade (16 patients in HG group and 18 patients in non-HG group) , there was no significant difference in baseline infarct volume (66.2±93.7 mL vs. 61.8±81.5 mL, P=0.746). However, Δinfarct volume was markedly larger in HG group than non-HG group (106.0±101.4 mL vs. 22.7±54.9 mL, P=0.002). Poor outcome (mRS 5 to 6) at discharge was more frequent in HG group than non-HG group, but the differences were not significantly (56.3% vs. 27.8%, P=0.163). In good collateral grade (34 patients in HG group and 25 patients in non-HG group), the baseline infarct volume did not differ between HG group and non-HD group (17.1±39.2 mL vs. 17.9±37.2 mL, P=0.569). However, Δinfarct volume was more larger in HG group than non-HG group (53.3±74.1 mL vs. 10.9±24.3 mL, P=0.047). Moreover, poor outcome at discharge was frequently observed in HG group than non-HG group (38.2% vs. 12.0%, P=0.038).
Conclusion: In patients with ICA and MCA occlusion, admission hyperglycemia should affect infarct volume expansion in poor as well as good collateral circulation.
- © 2012 by American Heart Association, Inc.