title: Admission hyperglycemia and serial infarct volume after t-PA therapy in patients with and without early recanalization.
abstract: OBJECTIVE
  The present study examined the effects of admission hyperglycemia and early recanalization (ER) after t-PA administration on infarct volume and patient outcome.
  
  
  METHODS
  Acute ischemic stroke patients with major artery occlusion treated with t-PA within 3h of onset were studied prospectively. Hyperglycemia was identified as admitting blood glucose value≥130 mg/dl. We compared serial infarct volume and patient outcome between normoglycemic and hyperglycemic groups, and assessed correlation between admitting blood glucose value and △infarct volume (7 days-baseline) between patients with and without ER.
  
  
  RESULTS
  97 patients (ICA occlusion in 30, M1 in 44, and M2 in 23 patients) were enrolled in the present study; 52 had hyperglycemia, and 40 had ER. The initial infarct volume did not differ between the normoglycemic and hyperglycemic groups. However, infarct volume at 7 days was larger in the hyperglycemic group than in the normoglycemic group (156.2±157.1cm(3), vs. 85.4±140.7 cm(3), P=0.0061) and the baseline admitting blood glucose value was correlated with Δinfarct volume (7 days-baseline) (r=0.340, P=0.0014). Regarding ER, Δinfarct volume (7 days-baseline) in patients without ER was correlated with admitting blood glucose value(r=0.372, P=0.0078). However, in patients with ER, Δinfarct volume was not associated with admitting blood glucose value (r=0.225, P=0.1173). Good outcome (mRS 0-2) at 3 months was more frequent in normoglycemic patients than hyperglycemic patients (43.2% vs. 22.2%, P=0.0418).
  
  
  CONCLUSIONS
  Admission hyperglycemia was associated with infarct volume expansion and patient outcome in t-PA patients. However, if ER occurs, hyperglycemia should not adversely affect infarct volume.
authors.affiliation: Department of Stroke Medicine, Kawasaki Medical School, Japan. kimurak@med.kawasaki-m.ac.jp
authors.forename: Kazumi
authors.initials: K
authors.lastname: Kimura
authors.forename: Yuki
authors.initials: Y
authors.lastname: Sakamoto
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Iguchi
authors.forename: Kensaku
authors.initials: K
authors.lastname: Shibazaki
authors.forename: Junya
authors.initials: J
authors.lastname: Aoki
authors.forename: Kenichiro
authors.initials: K
authors.lastname: Sakai
authors.forename: Junichi
authors.initials: J
authors.lastname: Uemura
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D020520:Brain Infarction / Q000188:drug therapy* / Q000453:epidemiology / Q000473:pathology*; D015897:Comorbidity; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D006943:Hyperglycemia / Q000453:epidemiology / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator