Abstract WMP77: Persistent Post Stroke Hyperglycemia Should Accelerate The Early Development Of Brain Infarct Volume: A Prospective Study Using By A Continuous Glucose Monitoring Device (CGMS).

Abstract

Background: Previous studies suggested that hyperglycemia was associated with infarct volume expansion in acute ischemic stroke patients. However, most studies have used a single time point measure (usually at admission) of blood glucose to define glycemia. The aim of the present study is to clarify the influence of persistent hyperglycemia after stroke assessed by a continuous glucose monitoring device (CGMS). Methods: Acute ischemic stroke patients with ICA and MCA occlusion within 24h of onset were prospectively studied. Continuous glucose monitoring was performed with a CGMS for 72h after admission.The patients were divided into two groups according to mean CGMS glucose value during 72h; persistent hyperglycemic group (mean CGMS glucose value ≥135mg/dl) and normoglycemic group (mean CGMS glucose value < 135mg/dl). Infarct volume was measured at admission, 24h and 72h after admission using DWI. We compared the change in infarct volume after 24h and 72h between the two groups. Multiple regression analysis was performed to identify variables that predicted the infarct volume expansion. Results: 33 patients were enrolled in the present study. During 72h monitoring, 17 patients (51.5%) had persistent hyperglycemia. Admission glucose value (129.0 mg/dl vs. 116.0 mg/dl, P=0.276) and HbA1c (5.6% vs. 5.5%, P=0.901) did not differ in the persistent hyperglycemic group and the normoglycemic group.The baseline infarct volume was similar in the two groups (59.1ml vs. 43.9 ml, P=0.709). However, the change in infarct volume after 24h was larger in the persistent hyperglycemic group than the normogycemic group (23.9 ml vs. 6.8ml, P=0.009). On the other hand, the change in infarct volume after 72h was not statistically different (41.7 ml vs. 28.7 ml, P=0.260). Multiple regression analysis indicated that persistent hyperglycemia (P=0.007) and no recanalization (P=0.027) were independently associated with infarct volume expansion after 24h. Conclusion: Persistent post stroke hyperglycemia independently affects infarct volume expansion after 24h but not 72h. These findings suggest that persistent hyperglycemia in the patients with large vessel occlusion should have a deleterious effect accelerating the early development of cerebra ischemia.