title: Admission Glucose and Effect of Intra-Arterial Treatment in Patients With Acute Ischemic Stroke.
abstract: Hyperglycemia on admission is common after ischemic stroke. It is associated with unfavorable outcome after treatment with intravenous thrombolysis and after intra-arterial treatment. Whether hyperglycemia influences the effect of reperfusion treatment is unknown. We assessed whether increased admission serum glucose modifies the effect of intra-arterial treatment in patients with acute ischemic stroke.
  
  
  
  We used data from the MR CLEAN (Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands). Hyperglycemia was defined as admission serum glucose >7.8 mmol/L. The primary outcome measure was the adjusted common odds ratio for a shift in the direction of a better outcome on the modified Rankin Scale at 90 days, estimated with ordinal logistic regression. Secondary outcome variable was symptomatic intracranial hemorrhage. We assessed treatment effect modification of hyperglycemia and admission serum glucose levels with multiplicative interaction factors and adjusted for prognostic variables.
  
  
  
  Four hundred eighty-seven patients were included. Mean admission serum glucose was 7.2 mmol/L (SD, 2.2). Fifty-seven of 226 patients (25%) randomized to intra-arterial treatment were hyperglycemic compared with 61 of 261 patients (23%) in the control group. The interaction of either hyperglycemia or admission serum glucose levels and treatment effect on modified Rankin Scale scores was not significant (P=0.67 andP=0.87, respectively). The same applied for occurrence of symptomatic hemorrhage (P=0.39 for hyperglycemia,P=0.39 for admission serum glucose).
  
  
  
  We found no evidence for effect modification of intra-arterial treatment by admission serum glucose in patients with acute ischemic stroke.
  
  
  
  URL: www.isrctn.com. Unique identifier: ISRCTN10888758.
authors.affiliation: From the Department of Neurology, Medical Spectrum Twente, Enschede, the Netherlands (H.M.d.H., E.O.); Departments of Neurology (O.A.B.) and Radiology (Y.B.W.E.M.R.), Academic Medical Center, Amsterdam, the Netherlands; Department of Neurology, Erasmus University Medical Center, Rotterdam, the Netherlands (P.S.S.F., P.J.K., D.W.J.D.); Department of Neurology, Maastricht University Medical Center, the Netherlands (D.B. R.J.v.O.); Department of Neurology, University Medical Center Utrecht, the Netherlands (W.J.S.); Department of Neurology, Medical Center Haaglanden, the Hague, the Netherlands (J.B.); Department of Internal Medicine, Ikazia Hospital, Rotterdam, the Netherlands (A.A.M.Z.); and Erasmus Medical Center (P.J.K., D.W.J.D.). e.osei@mst.nl.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Osei
authors.affiliation: From the Department of Neurology, Medical Spectrum Twente, Enschede, the Netherlands (H.M.d.H., E.O.); Departments of Neurology (O.A.B.) and Radiology (Y.B.W.E.M.R.), Academic Medical Center, Amsterdam, the Netherlands; Department of Neurology, Erasmus University Medical Center, Rotterdam, the Netherlands (P.S.S.F., P.J.K., D.W.J.D.); Department of Neurology, Maastricht University Medical Center, the Netherlands (D.B. R.J.v.O.); Department of Neurology, University Medical Center Utrecht, the Netherlands (W.J.S.); Department of Neurology, Medical Center Haaglanden, the Hague, the Netherlands (J.B.); Department of Internal Medicine, Ikazia Hospital, Rotterdam, the Netherlands (A.A.M.Z.); and Erasmus Medical Center (P.J.K., D.W.J.D.).
authors.forename: Heleen M
authors.initials: HM
authors.lastname: den Hertog
authors.affiliation: From the Department of Neurology, Medical Spectrum Twente, Enschede, the Netherlands (H.M.d.H., E.O.); Departments of Neurology (O.A.B.) and Radiology (Y.B.W.E.M.R.), Academic Medical Center, Amsterdam, the Netherlands; Department of Neurology, Erasmus University Medical Center, Rotterdam, the Netherlands (P.S.S.F., P.J.K., D.W.J.D.); Department of Neurology, Maastricht University Medical Center, the Netherlands (D.B. R.J.v.O.); Department of Neurology, University Medical Center Utrecht, the Netherlands (W.J.S.); Department of Neurology, Medical Center Haaglanden, the Hague, the Netherlands (J.B.); Department of Internal Medicine, Ikazia Hospital, Rotterdam, the Netherlands (A.A.M.Z.); and Erasmus Medical Center (P.J.K., D.W.J.D.).
authors.forename: Olvert A
authors.initials: OA
authors.lastname: Berkhemer
authors.affiliation: From the Department of Neurology, Medical Spectrum Twente, Enschede, the Netherlands (H.M.d.H., E.O.); Departments of Neurology (O.A.B.) and Radiology (Y.B.W.E.M.R.), Academic Medical Center, Amsterdam, the Netherlands; Department of Neurology, Erasmus University Medical Center, Rotterdam, the Netherlands (P.S.S.F., P.J.K., D.W.J.D.); Department of Neurology, Maastricht University Medical Center, the Netherlands (D.B. R.J.v.O.); Department of Neurology, University Medical Center Utrecht, the Netherlands (W.J.S.); Department of Neurology, Medical Center Haaglanden, the Hague, the Netherlands (J.B.); Department of Internal Medicine, Ikazia Hospital, Rotterdam, the Netherlands (A.A.M.Z.); and Erasmus Medical Center (P.J.K., D.W.J.D.).
authors.forename: Puck S S
authors.initials: PSS
authors.lastname: Fransen
authors.affiliation: From the Department of Neurology, Medical Spectrum Twente, Enschede, the Netherlands (H.M.d.H., E.O.); Departments of Neurology (O.A.B.) and Radiology (Y.B.W.E.M.R.), Academic Medical Center, Amsterdam, the Netherlands; Department of Neurology, Erasmus University Medical Center, Rotterdam, the Netherlands (P.S.S.F., P.J.K., D.W.J.D.); Department of Neurology, Maastricht University Medical Center, the Netherlands (D.B. R.J.v.O.); Department of Neurology, University Medical Center Utrecht, the Netherlands (W.J.S.); Department of Neurology, Medical Center Haaglanden, the Hague, the Netherlands (J.B.); Department of Internal Medicine, Ikazia Hospital, Rotterdam, the Netherlands (A.A.M.Z.); and Erasmus Medical Center (P.J.K., D.W.J.D.).
authors.forename: Yvo B W E M
authors.initials: YBWEM
authors.lastname: Roos
authors.affiliation: From the Department of Neurology, Medical Spectrum Twente, Enschede, the Netherlands (H.M.d.H., E.O.); Departments of Neurology (O.A.B.) and Radiology (Y.B.W.E.M.R.), Academic Medical Center, Amsterdam, the Netherlands; Department of Neurology, Erasmus University Medical Center, Rotterdam, the Netherlands (P.S.S.F., P.J.K., D.W.J.D.); Department of Neurology, Maastricht University Medical Center, the Netherlands (D.B. R.J.v.O.); Department of Neurology, University Medical Center Utrecht, the Netherlands (W.J.S.); Department of Neurology, Medical Center Haaglanden, the Hague, the Netherlands (J.B.); Department of Internal Medicine, Ikazia Hospital, Rotterdam, the Netherlands (A.A.M.Z.); and Erasmus Medical Center (P.J.K., D.W.J.D.).
authors.forename: Debbie
authors.initials: D
authors.lastname: Beumer
authors.affiliation: From the Department of Neurology, Medical Spectrum Twente, Enschede, the Netherlands (H.M.d.H., E.O.); Departments of Neurology (O.A.B.) and Radiology (Y.B.W.E.M.R.), Academic Medical Center, Amsterdam, the Netherlands; Department of Neurology, Erasmus University Medical Center, Rotterdam, the Netherlands (P.S.S.F., P.J.K., D.W.J.D.); Department of Neurology, Maastricht University Medical Center, the Netherlands (D.B. R.J.v.O.); Department of Neurology, University Medical Center Utrecht, the Netherlands (W.J.S.); Department of Neurology, Medical Center Haaglanden, the Hague, the Netherlands (J.B.); Department of Internal Medicine, Ikazia Hospital, Rotterdam, the Netherlands (A.A.M.Z.); and Erasmus Medical Center (P.J.K., D.W.J.D.).
authors.forename: Robert J
authors.initials: RJ
authors.lastname: van Oostenbrugge
authors.affiliation: From the Department of Neurology, Medical Spectrum Twente, Enschede, the Netherlands (H.M.d.H., E.O.); Departments of Neurology (O.A.B.) and Radiology (Y.B.W.E.M.R.), Academic Medical Center, Amsterdam, the Netherlands; Department of Neurology, Erasmus University Medical Center, Rotterdam, the Netherlands (P.S.S.F., P.J.K., D.W.J.D.); Department of Neurology, Maastricht University Medical Center, the Netherlands (D.B. R.J.v.O.); Department of Neurology, University Medical Center Utrecht, the Netherlands (W.J.S.); Department of Neurology, Medical Center Haaglanden, the Hague, the Netherlands (J.B.); Department of Internal Medicine, Ikazia Hospital, Rotterdam, the Netherlands (A.A.M.Z.); and Erasmus Medical Center (P.J.K., D.W.J.D.).
authors.forename: Wouter J
authors.initials: WJ
authors.lastname: Schonewille
authors.affiliation: From the Department of Neurology, Medical Spectrum Twente, Enschede, the Netherlands (H.M.d.H., E.O.); Departments of Neurology (O.A.B.) and Radiology (Y.B.W.E.M.R.), Academic Medical Center, Amsterdam, the Netherlands; Department of Neurology, Erasmus University Medical Center, Rotterdam, the Netherlands (P.S.S.F., P.J.K., D.W.J.D.); Department of Neurology, Maastricht University Medical Center, the Netherlands (D.B. R.J.v.O.); Department of Neurology, University Medical Center Utrecht, the Netherlands (W.J.S.); Department of Neurology, Medical Center Haaglanden, the Hague, the Netherlands (J.B.); Department of Internal Medicine, Ikazia Hospital, Rotterdam, the Netherlands (A.A.M.Z.); and Erasmus Medical Center (P.J.K., D.W.J.D.).
authors.forename: Jelis
authors.initials: J
authors.lastname: Boiten
authors.affiliation: From the Department of Neurology, Medical Spectrum Twente, Enschede, the Netherlands (H.M.d.H., E.O.); Departments of Neurology (O.A.B.) and Radiology (Y.B.W.E.M.R.), Academic Medical Center, Amsterdam, the Netherlands; Department of Neurology, Erasmus University Medical Center, Rotterdam, the Netherlands (P.S.S.F., P.J.K., D.W.J.D.); Department of Neurology, Maastricht University Medical Center, the Netherlands (D.B. R.J.v.O.); Department of Neurology, University Medical Center Utrecht, the Netherlands (W.J.S.); Department of Neurology, Medical Center Haaglanden, the Hague, the Netherlands (J.B.); Department of Internal Medicine, Ikazia Hospital, Rotterdam, the Netherlands (A.A.M.Z.); and Erasmus Medical Center (P.J.K., D.W.J.D.).
authors.forename: Adrienne A M
authors.initials: AAM
authors.lastname: Zandbergen
authors.affiliation: From the Department of Neurology, Medical Spectrum Twente, Enschede, the Netherlands (H.M.d.H., E.O.); Departments of Neurology (O.A.B.) and Radiology (Y.B.W.E.M.R.), Academic Medical Center, Amsterdam, the Netherlands; Department of Neurology, Erasmus University Medical Center, Rotterdam, the Netherlands (P.S.S.F., P.J.K., D.W.J.D.); Department of Neurology, Maastricht University Medical Center, the Netherlands (D.B. R.J.v.O.); Department of Neurology, University Medical Center Utrecht, the Netherlands (W.J.S.); Department of Neurology, Medical Center Haaglanden, the Hague, the Netherlands (J.B.); Department of Internal Medicine, Ikazia Hospital, Rotterdam, the Netherlands (A.A.M.Z.); and Erasmus Medical Center (P.J.K., D.W.J.D.).
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Koudstaal
authors.affiliation: From the Department of Neurology, Medical Spectrum Twente, Enschede, the Netherlands (H.M.d.H., E.O.); Departments of Neurology (O.A.B.) and Radiology (Y.B.W.E.M.R.), Academic Medical Center, Amsterdam, the Netherlands; Department of Neurology, Erasmus University Medical Center, Rotterdam, the Netherlands (P.S.S.F., P.J.K., D.W.J.D.); Department of Neurology, Maastricht University Medical Center, the Netherlands (D.B. R.J.v.O.); Department of Neurology, University Medical Center Utrecht, the Netherlands (W.J.S.); Department of Neurology, Medical Center Haaglanden, the Hague, the Netherlands (J.B.); Department of Internal Medicine, Ikazia Hospital, Rotterdam, the Netherlands (A.A.M.Z.); and Erasmus Medical Center (P.J.K., D.W.J.D.).
authors.forename: Diederik W J
authors.initials: DWJ
authors.lastname: Dippel
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001786:Blood Glucose; D002545:Brain Ischemia / Q000097:blood* / Q000000981:diagnostic imaging / Q000628:therapy*; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000097:blood*; D020300:Intracranial Hemorrhages; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D016037:Single-Blind Method; D015607:Stents; D020521:Stroke / Q000097:blood* / Q000000981:diagnostic imaging / Q000628:therapy*; D017131:Thrombectomy / Q000379:methods*
chemical_list: D001786:Blood Glucose
keywords: glucose; hemorrhages; hyperglycemia; stroke; thrombectomy