Abstract
Background: One in 10 ischemic strokes are large hemispheric infarctions (LHI), half of which cause cerebral edema that can lead to significant mortality. Our center implemented a protocol using acute glyburide in patients with LHI to determine its safety and efficacy in reducing formation of cerebral edema. Methods: Consecutive adult patients at our center (10/2019-08/2021) with LHI who met criteria for the CHARM trial were treated with glyburide per an institutional protocol (2.5mg per nasogastric tube twice daily for 3 days) with multi-disciplinary oversight. Unadjusted logistic regression was used to estimate odds of a favorable shift in 90-day modified Rankin Scale (mRS), with adjustment for age, pre-stroke mRS, National Institutes of Health Stroke Scale (NIHSS) and large vessel occlusion (LVO). Propensity-score matching was used to model shift in 90-day mRS. Safety events were also assessed. Results: Of 1684 stroke patients treated at our center, 95 met criteria for CHARM and were included, among whom 21 completed the glyburide protocol (28 attempted) and 67 received standard-of-care (SOC); 34 patients were propensity-matched (nglyburide=17). Compared to SOC (n=67), patients treated with glyburide (n=21) had similar pre-stroke mRS, NIHSS, and LVOs, but were younger (median 61y vs. 67y, p<0.01). Glyburide was not associated with a favorable shift in 90-day mRS in unadjusted (OR 1.40, 95%CI 0.51-3.88) or adjusted regression (OR 0.71, 95%CI 0.17-2.94), or following propensity score matching (OR 1.39, 95%CI 0.32-6.07). There was no significant reduction in midline shift in unadjusted, adjusted, or propensity score-matched models (p>0.05). Two patients required D50 rescue, and 1 did not complete the protocol due to recurrent hypoglycemia. Conclusions: In this single center analysis, glyburide was found to have a low risk of hypoglycemic events. Despite the small sample size, there was no signal of better clinical or imaging outcomes in treated patients.
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