title: Admission hyperglycemia causes infarct volume expansion in patients with ICA or MCA occlusion: association of collateral grade on conventional angiography.
abstract: OBJECTIVE
  Hyperglycemia (HG) is associated with infarct volume expansion in acute ischaemic stroke patients. However, collateral circulation can sustain the ischaemic penumbra and limit the growth of infarct volume. The aim of this study was to determine whether the association between HG and infarct volume expansion is dependent on collateral circulation.
  
  
  METHODS
  We performed a retrospective analysis of 93 acute ischaemic stroke patients with internal carotid artery or middle cerebral artery occlusion within 24 h of onset were retrospectively studied. HG was diagnosed in patients with an admitting blood glucose value ≥140 mg/dl. Angiographic collateral grade 0-1 was designated as poor collateral circulation and grade 2-4 as good collateral circulation. Infarct volume was measured at admission and at again within 7 days using diffusion-weighted magnetic resonance images.
  
  
  RESULTS
  Among 34 patients with poor collateral grade, the change in infarct volume was significantly greater in the HG group than in the non-HG group (106.0 ml vs. 22.7 ml, P = 0.002). Among the 59 patients with good collateral circulation, the change in infarct volume was greater in the HG group than in the non-HG group (53.3 ml vs. 10.9 ml, P = 0.047). Multiple regression analysis indicated that admission HG (P = 0.004), baseline National Institutes of Health Stroke Scale score (P = 0.018), and poor collateral circulation (P = 0.040) were independently associated with infarct volume expansion.
  
  
  CONCLUSIONS
  Infarct volume expansion was greater in individuals with HG on admission regardless of collateral circulation status.
authors: Department of Stroke Medicine, Kawasaki Medical School, Kurashiki City Okayama, Japan. t.shimo0702@gmail.com
authors: T
authors: T
authors: Shimoyama
authors: K
authors: K
authors: Shibazaki
authors: K
authors: K
authors: Kimura
authors: J
authors: J
authors: Uemura
authors: T
authors: T
authors: Shiromoto
authors: M
authors: M
authors: Watanabe
authors: T
authors: T
authors: Inoue
authors: Y
authors: Y
authors: Iguchi
authors: S
authors: S
authors: Mochio
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography; D001786:Blood Glucose; D020520:Brain Infarction / Q000150:complications / Q000209:etiology / Q000473:pathology; D002340:Carotid Artery Diseases / Q000150:complications* / Q000628:therapy; D057510:Endovascular Procedures / Q000379:methods; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000000981:diagnostic imaging / Q000209:etiology*; D020244:Infarction, Middle Cerebral Artery / Q000150:complications* / Q000628:therapy; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use
chemical_list: D001786:Blood Glucose; D010959:Tissue Plasminogen Activator