Heterogeneity affecting outcome from acute stroke therapy: making reperfusion worse.
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.
Kent
T A
TA
Department of Neurology, Marine Biomedical Institute, University of Texas Medical Branch, Galveston, TX 77555, USA. thomas.kent@utmb.edu
Soukup
V M
VM
Fabian
R H
RH
D000208:Acute Disease; D002986:Clinical Trials as Topic; D016207:Cytokines / Q000378:metabolism; D018450:Disease Progression; D006801:Humans; D006943:Hyperglycemia / Q000150:complications*; D007239:Infections / Q000150:complications* / Q000503:physiopathology; D016328:NF-kappa B / Q000378:metabolism; D018384:Oxidative Stress; D017382:Reactive Oxygen Species / Q000378:metabolism; D011994:Recombinant Proteins / Q000627:therapeutic use; D015424:Reperfusion / Q000009:adverse effects*; D015427:Reperfusion Injury / Q000175:diagnosis / Q000209:etiology*; D018570:Risk Assessment; D020521:Stroke / Q000150:complications* / Q000503:physiopathology / Q000628:therapy*; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use; D016896:Treatment Outcome
D016207:Cytokines; D016328:NF-kappa B; D017382:Reactive Oxygen Species; D011994:Recombinant Proteins; D010959:Tissue Plasminogen Activator