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Original research
Hyperglycemic control in acute ischemic stroke patients undergoing endovascular treatment: post hoc analysis of the Stroke Hyperglycemia Insulin Network Effort trial
  1. Navpreet K Bains1,2,
  2. Wei Huang1,2,
  3. Brandi R French1,2,
  4. Farhan Siddiq2,3,
  5. Camilo R Gomez1,2,
  6. Adnan I Qureshi1,2
  1. 1Neurology, University of Missouri, Columbia, Missouri, USA
  2. 2Neurology, Zeenat Qureshi Stroke Institute, St. Cloud, Minnesota, USA
  3. 3Neurosurgery, University of Missouri, Columbia, Missouri, USA
  1. Correspondence to Dr Navpreet K Bains, Neurology, University of Missouri, Columbia, Missouri, USA; bainsn{at}health.missouri.edu

Abstract

Background Hyperglycemia has been associated with poor outcomes in acute ischemic stroke patients undergoing endovascular treatment. We analyzed the effect of intensive glucose control on death and disability rates in patients with acute ischemic stroke undergoing endovascular treatment.

Methods We analyzed the effect of intensive (serum glucose <110 mg/dL) glucose treatment (compared with standard treatment, serum glucose <180 mg/dL) in patients who received endovascular treatment in the Stroke Hyperglycemia Insulin Network Effort (SHINE) trial. We further analyzed the effect of area under the curve (AUC) of serum glucose, proportion of the time blood glucose was <140 mg/dL, and glucose variability defined as the glucose range during 72 hours. The primary outcomes were neurological deterioration within 72 hours and outcome at 90 days.

Results A total of 146 patients (mean age 68.1±13.9 years, 50.7% men) underwent endovascular treatment for acute ischemic stroke; 72 and 74 patients were randomized to intensive and standard treatments, respectively. The rates of death (20.3% and 22.2%), favorable 90-day primary outcome (17.6% and 19.4%), and serious adverse events (41.9% and 56.98%) were similar between the two groups. The AUC of serum glucose was not associated with death within 90 days (OR 1, 95% CI 1 to 1) or favorable outcome at 90 days (OR 1, 95% CI 1 to 1). Glucose variability was not associated with death or favorable outcome at 90 days.

Conclusion We did not identify any beneficial effect of intensive glucose reduction on rates of death or favorable outcomes at 90 days among acute ischemic stroke patients undergoing endovascular treatment.

  • Stroke
  • Intervention
  • Thrombectomy
  • Inflammatory Response

Data availability statement

Data sharing not applicable as no datasets generated and/or analysed for this study. All data relevant to the study are included in the article or uploaded as supplementary information. Not applicable.

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Data availability statement

Data sharing not applicable as no datasets generated and/or analysed for this study. All data relevant to the study are included in the article or uploaded as supplementary information. Not applicable.

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Footnotes

  • Contributors Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work: NB, AQ and WH. Drafting the work or revising it critically for important intellectual content: NB and AQ. Final approval of the version to be published: NB, WH, BF, FS, CRG and AQ. Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved: NB, WH, BF, FS, CRG and AQ. Guarantor: AQ

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.