@article{9ef92a4879654da2a4d00ec056068c09,
title = "Glucose Modifies the Effect of Endovascular Thrombectomy in Patients With Acute Stroke A Pooled-Data Meta-Analysis",
abstract = "Background and Purpose-Hyperglycemia is a negative prognostic factor after acute ischemic stroke but is not known whether glucose is associated with the effects of endovascular thrombectomy (EVT) in patients with large-vessel stroke. In a pooled-data meta-analysis, we analyzed whether serum glucose is a treatment modifier of the efficacy of EVT in acute stroke.Methods-Seven randomized trials compared EVT with standard care between 2010 and 2017 (HERMES Collaboration [highly effective reperfusion using multiple endovascular devices]). One thousand seven hundred and sixty-four patients with large-vessel stroke were allocated to EVT (n=871) or standard care (n=893). Measurements included blood glucose on admission and functional outcome (modified Rankin Scale range, 0-6; lower scores indicating less disability) at 3 months. The primary analysis evaluated whether glucose modified the effect of EVT over standard care on functional outcome, using ordinal logistic regression to test the interaction between treatment and glucose level.Results-Median (interquartile range) serum glucose on admission was 120 (104-140) mg/dL (6.6 mmol/L [5.7-7.7] mmol/L). EVT was better than standard care in the overall pooled-data analysis adjusted common odds ratio (acOR), 2.00 (95% CI, 1.69-2.38); however, lower glucose levels were associated with greater effects of EVT over standard care. The interaction was nonlinear such that significant interactions were found in subgroups of patients split at glucose < or >90 mg/dL (5.0 mmol/L; P=0.019 for interaction; acOR, 3.81; 95% CI, 1.73-8.41 for patients < 90 mg/dL versus 1.83; 95% CI, 1.53-2.19 for patients >90 mg/dL), and glucose < or > 100 mg/dL (5.5 mmol/L; P=0.004 for interaction; acOR, 3.17; 95% CI, 2.04-4.93 versus acOR, 1.72; 95% CI, 1.42-2.08) but not between subgroups above these levels of glucose.Conclusions-EVT improved stroke outcomes compared with standard treatment regardless of glucose levels, but the treatment effects were larger at lower glucose levels, with significant interaction effects persisting up to 90 to 100 mg/dL (5.0-5.5 mmol/L). Whether tight control of glucose improves the efficacy of EVT after large-vessel stroke warrants appropriate testing. (Stroke. 2019;50:690-696. DOI: 10.1161/STROKEAHA.118.023769.)",
keywords = "acute ischemic-stroke, admission glucose, blood glucose, hyperglycemia, intraarterial treatment, mechanical thrombectomy, meta-analysis, outcomes, oxidative stress, patients, poststroke hyperglycemia, therapy, thrombectomy, trial, uric-acid, POSTSTROKE HYPERGLYCEMIA, THERAPY, ACUTE ISCHEMIC-STROKE, OXIDATIVE STRESS, MECHANICAL THROMBECTOMY, TRIAL, INTRAARTERIAL TREATMENT, OUTCOMES, ADMISSION GLUCOSE, URIC-ACID",
author = "A. Chamorro and S. Brown and S. Amaro and M.D. Hill and K.W. Muir and D.W.J. Dippel and {van Zwam}, W. and K. Butcher and G.A. Ford and {den Hertog}, H.M. and P.J. Mitchell and A.M. Demchuk and C.B.L.M. Majoie and S. Bracard and I. Sibon and A.P. Jadhav and B. Lara-Rodriguez and {van der Lugt}, A. and E. Osei and A. Renu and S. Richard and D. Rodriguez-Luna and G.A. Donnan and A. Dixit and M. Almekhlafi and S. Deltour and J. Epstein and B. Guillon and S. Bakchine and M. Gomis and R.D. Rochemont and D. Lopes and V. Reddy and G. Rudel and Y.B.W.E.M. Roos and A. Bonafe and H.C. Diener and O.A. Berkhemer and G.C. Cloud and S.M. Davis and {van Oostenbrugge}, R. and F. Guillemin and M. Goyal and B.C.V. Campbell and B.K. Menon and {HERMES Collaboration}",
note = "Funding Information: Dr Chamorro owns stock in FreeOx Biotech SL and has received consultancy fees from Boehringer Ingelheim. Dr Donnan reports grants from National Health and Medical Research Council, Astra Zeneca, Boehringer Ingelheim, Bristol Meyers Squibb, Pfizer, and Servier. Dr Campbell reports grants from National Health and Medical Research Council, Royal Australasian College of Physicians, Royal Melbourne Hospital Foundation, National Heart Foundation, National Stroke Foundation of Australia, and Covidien (Medtronic). Dr Ford reports personal fees or grants from Stryker, Pfizer, Bayer, AstraZeneca, Medtronic, and Cerevast. Dr Hill has received grant support from Medtronic LLC, Consultant fees from Boehringer Ingelheim, and speaker{\textquoteright}s fees from Amgen. Dr van der Lugt reports grants from Dutch Heart Foundation, AngioCare BV, Covidien/EV3, MEDAC Gmbh/LAMEPRO, Stryker{\textregistered}, Penumbra Inc, and Medtronic. Dr Majoie is shareholder of Nico.lab and reports research support from the Netherlands CardioVascular Research Committee/Dutch Heart Foundation, European Commission, and Stryker. Dr Muir reports grants from Medtronic, and Codman. Dr van Zwam reports personal fees from Cerenovus, and Stryker. Dr Roos reports other from Stock owner of Nico-Lab. Dr Diener received fees from Abbott, Achelios, Allergan, AstraZeneca, Bayer Vital, BMS, Boehringer Ingelheim, CoAxia, Corimmol/lun, Covidien, Daiichi-Sankyo, D-Pharm, Fresenius, GlaxoSmithKline, Janssen-Cilag, Johnson & Johnson, Knoll, Lilly, MSD, Medscape, Medtronic, MindFrame, Neurobiological Technologies, Novartis, Novo-Nordisk, Paion, Parke-Davis, Pfizer, Portola, Sanofi-Aventis, Schering-Plough, Servier, Solvay, St Jude, Syngis, Talecris, Thrombogenics, WebMD Global, Wyeth, and Yamanouchi. Financial support for research projects was provided by AstraZeneca, GSK, Boehringer Ingelheim, Lundbeck, Novartis, Janssen-Cilag, Sanofi-Aventis, Syngis, and Talecris. The Department of Neurology at the University Duisburg-Essen received research grants from the German Research Council, German Ministry of Education and Research, European Union, National Institutes of Health, Bertelsmann Foundation and Heinz-Nixdorf Foundation. Dr Demchuk reports personal fees from Medtronic. Dr Bonaf{\'e} reports personal fees from Medtronic, Stryker, and Phenox. Dr Mitchell reports other or personal fees from Medtronic, Stryker, and Microvention. Dr Brown reports personal fees from University of Calgary and Medtronic. Dr Reimann reports personal fees from Bayer, Boehringer Ingelheim, Pfizer, and Daiichi Sankyo. Dr Goyal reports grants or personal fees from Medtronic, Stryker, Microvention, Cerenovus, and has a patent Systems of Acute Stroke Diagnosis issued to GE Healthcare. Dr Dippel reports grants from Dutch Heart Foundation, Brain Foundation Netherlands, The Netherlands Organisation for Health Research and Development, Health Holland Top Sector Life Sciences & Health and unrestricted grants from AngioCare BV, Covidien/EV3, MEDAC Gmbh/ LAMEPRO, Penumbra Inc, Top Medical/Concentric, Stryker, Stryker European Operations BV, Medtronic, Thrombolytic Science, LLC, all paid to institution. Dr Berkhemer reports that Academic Medical Center received funds from Stryker for consultation. Dr du Mesnil de Rochemont reports SWIFT PRIME funding. Dr Davis reports speakers fees from Boehringer Ingelheim. The other authors report no conflicts. Publisher Copyright: {\textcopyright} 2019 American Heart Association, Inc.",
year = "2019",
month = mar,
day = "1",
doi = "10.1161/STROKEAHA.118.023769",
language = "English",
volume = "50",
pages = "690--696",
journal = "Stroke",
issn = "0039-2499",
publisher = "LIPPINCOTT WILLIAMS & WILKINS",
number = "3",
}