Stroke : Highlights of Selected Articles

Abstract

HomeStrokeVol. 44, No. 8Stroke: Highlights of Selected Articles Free AccessResearch ArticlePDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessResearch ArticlePDF/EPUBStroke: Highlights of Selected Articles Originally published1 Aug 2013https://doi.org/10.1161/STROKEAHA.113.002626Stroke. 2013;44:2092Glycosylated Hemoglobin A1 Predicts Risk for Symptomatic Hemorrhage After Thrombolysis for Acute StrokeSymptomatic intracerebral hemorrhage after intravenous treatment with tissue-type plasminogen activator (tPA) in acute ischemic stroke is a potentially devastating event with a high mortality rate. Many factors are thought to increase the risk of hemorrhage, including damage to the microvasculature. Hemoglobin A1 (HbA1c) is a marker for long-term elevated glucose level and is used for monitoring diabetic vascular damage. In this retrospective analysis, Rocco et al investigated the predictive value of HbA1c for symptomatic intracerebral hemorrhage and clinical outcome in patients treated with intravenous tPA for acute ischemic stroke. The authors reviewed >1000 patients treated with tPA from 1998 to 2011 at the Neurological Department in Heidelberg, Germany. Any hemorrhage occurred in 222 patients (19.9%); 43 of those had symptomatic intracerebral hemorrhage (3.9%) per Safe Implementation of Treatments in Stroke definition and 95 (8.5%) per National Institute of Neurological Disorders and Stroke definition. In multivariate analysis, HbA1c was highly significantly associated with any hemorrhage and symptomatic intracerebral hemorrhage with a cut-off value of 6.5%, regardless of the definition used. By contrast, blood glucose at baseline was not statistically significantly associated with any type of hemorrhage. In multivariate analysis, age, National Institutes of Health Stroke Scale score on admission, and HbA1c were predictors of dependent outcome (modified Rankin Scale, 3–5). HbA1c is an important predictor of symptomatic intracerebral hemorrhage after thrombolysis for acute ischemic stroke. These results suggest that hemorrhage after thrombolysis may be a consequence of long-term vascular injury rather than of acute hyperglycemia. Patients should not be excluded from intravenous tPA with elevated HbA1c. However, if validated in larger prospective studies, these patients may warrant more intensive monitoring following tPA. See p 2134.Size Ratio Can Highly Predict Rupture Risk in Intracranial Small (<5 mm) AneurysmsThe decision-making process in the management of unruptured cerebral aneurysms is controversial. The risk of rupture increases with increasing aneurysm size. There are, however, a significant number of cases of subarachnoid hemorrhage from ruptured aneurysms <5 mm. Most studies use aneurysm diameter as a clinical variable when assessing risk of rupture. This study aimed to identify other parameters that highly predict the rupture risk of small (<5 mm) unruptured cerebral aneurysms. They reviewed a prospective cohort of 854 aneurysmal subarachnoid hemorrhage patients from 2003 and 2011 in Sapporo City, Japan. The size, aneurysm-to-vessel size ratio, and distribution were precisely compared between the ruptured and unruptured aneurysms. The size ratio was defined as the ratio of the maximum aneurysm diameter to the average vessel diameter. The most frequent site of ruptured aneurysm was at the anterior communicating artery, and the most frequent site of unruptured aneurysm was the middle cerebral artery. The maximal diameter and the size ratio were significantly higher in the ruptured group than unruptured. In multivariate analysis, both size and size ratio were correlated with aneurysm rupture. Specifically regarding the small aneurysms, 27% of the ruptured cerebral aneurysms were <5 mm. In multivariate analysis, only size ratio was associated with rupture in the small aneurysm group. These results should be validated in further, large prospective registries. However, based on these results, the calculation of size ratio may represent a good marker of rupture risk in small aneurysms. See p 2169.Systemic Inflammatory Response Syndrome in Tissue-Type Plasminogen Activator–Treated Patients is Associated With Worse Short-term Functional OutcomeSystemic inflammatory response (SIRS) is a generalized inflammatory state. Previous research has shown that patients with severe acute ischemic stroke have increased risk of having SIRS. In the current study, the investigators looked at the differences in outcomes in SIRS and non-SIRS tissue-type plasminogen activator–treated patients. They retrospectively reviewed their stroke database from 2008 to 2011 for patients with SIRS, excluding patients with infection. Out of 241 tissue-type plasminogen activator–treated patients included in this study, 44 had evidence of SIRS (18.2%). Patients with SIRS were more likely to be black and had lower median total cholesterol at baseline. SIRS patients were more likely to have longer length of stay and greater odds of poor functional outcome. Adjusting for baseline National Institutes of Health Stroke Scale, age, and race, SIRS remained a predictor of poor functional outcome at discharge. SIRS was not a predictor of poor discharge disposition or in-hospital mortality. Larger prospective studies are needed to validate these results, which are limited due to the small sample size and retrospective nature. See p 2322. Previous Back to top Next FiguresReferencesRelatedDetails August 2013Vol 44, Issue 8 Advertisement Article InformationMetrics © 2013 American Heart Association, Inc.https://doi.org/10.1161/STROKEAHA.113.002626 Originally publishedAugust 1, 2013 PDF download Advertisement