Effect of Hemoglobin and Blood Glucose Levels on CT Perfusion Ischemic Core Estimation: A Post Hoc Analysis of the ESCAPE-NA1 Trial.

Humans Female Male Aged Ischemic Stroke / diagnostic imaging Blood Glucose / metabolism Hemoglobins / metabolism Middle Aged Tomography, X-Ray Computed Cerebrovascular Circulation / physiology Aged, 80 and over Anemia / blood Thrombectomy / methods Brain Ischemia / diagnostic imaging Perfusion Imaging Hyperglycemia / blood

Journal

Neurology
ISSN: 1526-632X
Titre abrégé: Neurology
Pays: United States
ID NLM: 0401060

Informations de publication

Date de publication:
26 Nov 2024
Historique:
medline: 22 10 2024
pubmed: 21 10 2024
entrez: 21 10 2024
Statut: ppublish

Résumé

CT perfusion (CTP) maps can estimate the ischemic core in acute ischemic stroke based on distinctive cerebral blood flow thresholds. However, metabolic factors beyond perfusion influence the tissue tolerance to ischemia and the infarct growth rate. Underestimating the ischemic core volume (ICV) might result in overestimating the salvageable cerebral tissue and, consequently, overestimating the potential clinical benefits of reperfusion therapies. We aim to evaluate whether baseline hemoglobin and blood glucose levels influence the accuracy of baseline CTP ICV estimations. Large vessel occlusion stroke patients investigated with baseline CTP undergoing thrombectomy with near-complete reperfusion and without parenchymal hemorrhage from the ESCAPE-NA1 trial were included. Patients were subdivided into anemic (hemoglobin <130 g/L for men and <120 g/L for women) and nonanemic groups, and hyperglycemic (blood glucose level >7 mmol/L) and normoglycemic groups. Ischemic core underestimated volume (ICuV) was calculated: final infarct volume minus CTP-based ICV. The primary outcome was the presence of "perfusion scotoma" defined as ICuV ≥10 mL. Presence of "perfusion scotoma" and median ICuV were compared between anemic vs nonanemic and hyperglycemic vs normoglycemic patients using nonparametric tests and multivariable binary logistic regression with adjustment for baseline variables. One hundred sixty-two of 1,105 (15%) patients were included (median age 70.5 [interquartile range (IQR) 61-80.4], 50.6% women). The median ICuV was 7.26 mL (IQR 0-25.63). Seventy-eight (48%) patients demonstrated perfusion scotoma. Forty-two (25.7%) patients were anemic, and 65 (40.1%) were hyperglycemic. In univariable analysis, the hyperglycemic group had a higher prevalence of perfusion scotoma (65% [n = 40] vs 39% [n = 38], In our study, CTP-based ischemic core underestimation was common and associated with higher baseline blood glucose levels. Individual metabolic factors beyond perfusion that critically influence the infarct growth rate should be considered when interpreting baseline CTP estimations of ischemic core.

Sections du résumé

BACKGROUND AND OBJECTIVES OBJECTIVE
CT perfusion (CTP) maps can estimate the ischemic core in acute ischemic stroke based on distinctive cerebral blood flow thresholds. However, metabolic factors beyond perfusion influence the tissue tolerance to ischemia and the infarct growth rate. Underestimating the ischemic core volume (ICV) might result in overestimating the salvageable cerebral tissue and, consequently, overestimating the potential clinical benefits of reperfusion therapies. We aim to evaluate whether baseline hemoglobin and blood glucose levels influence the accuracy of baseline CTP ICV estimations.
METHODS METHODS
Large vessel occlusion stroke patients investigated with baseline CTP undergoing thrombectomy with near-complete reperfusion and without parenchymal hemorrhage from the ESCAPE-NA1 trial were included. Patients were subdivided into anemic (hemoglobin <130 g/L for men and <120 g/L for women) and nonanemic groups, and hyperglycemic (blood glucose level >7 mmol/L) and normoglycemic groups. Ischemic core underestimated volume (ICuV) was calculated: final infarct volume minus CTP-based ICV. The primary outcome was the presence of "perfusion scotoma" defined as ICuV ≥10 mL. Presence of "perfusion scotoma" and median ICuV were compared between anemic vs nonanemic and hyperglycemic vs normoglycemic patients using nonparametric tests and multivariable binary logistic regression with adjustment for baseline variables.
RESULTS RESULTS
One hundred sixty-two of 1,105 (15%) patients were included (median age 70.5 [interquartile range (IQR) 61-80.4], 50.6% women). The median ICuV was 7.26 mL (IQR 0-25.63). Seventy-eight (48%) patients demonstrated perfusion scotoma. Forty-two (25.7%) patients were anemic, and 65 (40.1%) were hyperglycemic. In univariable analysis, the hyperglycemic group had a higher prevalence of perfusion scotoma (65% [n = 40] vs 39% [n = 38],
DISCUSSION CONCLUSIONS
In our study, CTP-based ischemic core underestimation was common and associated with higher baseline blood glucose levels. Individual metabolic factors beyond perfusion that critically influence the infarct growth rate should be considered when interpreting baseline CTP estimations of ischemic core.

Identifiants

DOI: 10.1212/WNL.0000000000209939 PMID: 39432874
pubmed: 39432874
doi: 10.1212/WNL.0000000000209939
doi:

Substances chimiques

Blood Glucose 0
Hemoglobins 0

Types de publication

Journal Article Randomized Controlled Trial

Langues

eng

Sous-ensembles de citation

IM

Pagination

e209939

Auteurs

Umberto Pensato (U)

From the IRCCS Humanitas Research Hospital (U.P.); Department of Biomedical Sciences (U.P.), Humanitas University, Milan, Italy; Calgary Stroke Program (U.P., S.B., A.S., A.M.D., M.D.H.), Departments of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Alberta, Canada; Institute of Radiology (A.S.), Cantonal Hospital Münsterlingen, Switzerland; University of British Columbia (A.R.), Vancouver, Canada; Royal Adelaide Hospital (T.J.K.), Adelaide, Australia; Wellstar Health Systems (R.G.), Kennestone Hospital, Marietta, GA; Department of Neurology (G.T.) and Department of Neuroradiology (G.T.), University Medical Center Hamburg-Eppendorf, Germany; University College of Medicine (J.H.H.), Seoul, South Korea; and Department of Radiology (M.G., M.D.H., J.M.O.), Cumming School of Medicine, University of Calgary, Alberta, Canada.
ORCID: 0000-0002-4042-4735

Salome Bosshart (S)

From the IRCCS Humanitas Research Hospital (U.P.); Department of Biomedical Sciences (U.P.), Humanitas University, Milan, Italy; Calgary Stroke Program (U.P., S.B., A.S., A.M.D., M.D.H.), Departments of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Alberta, Canada; Institute of Radiology (A.S.), Cantonal Hospital Münsterlingen, Switzerland; University of British Columbia (A.R.), Vancouver, Canada; Royal Adelaide Hospital (T.J.K.), Adelaide, Australia; Wellstar Health Systems (R.G.), Kennestone Hospital, Marietta, GA; Department of Neurology (G.T.) and Department of Neuroradiology (G.T.), University Medical Center Hamburg-Eppendorf, Germany; University College of Medicine (J.H.H.), Seoul, South Korea; and Department of Radiology (M.G., M.D.H., J.M.O.), Cumming School of Medicine, University of Calgary, Alberta, Canada.

Alexander Stebner (A)

From the IRCCS Humanitas Research Hospital (U.P.); Department of Biomedical Sciences (U.P.), Humanitas University, Milan, Italy; Calgary Stroke Program (U.P., S.B., A.S., A.M.D., M.D.H.), Departments of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Alberta, Canada; Institute of Radiology (A.S.), Cantonal Hospital Münsterlingen, Switzerland; University of British Columbia (A.R.), Vancouver, Canada; Royal Adelaide Hospital (T.J.K.), Adelaide, Australia; Wellstar Health Systems (R.G.), Kennestone Hospital, Marietta, GA; Department of Neurology (G.T.) and Department of Neuroradiology (G.T.), University Medical Center Hamburg-Eppendorf, Germany; University College of Medicine (J.H.H.), Seoul, South Korea; and Department of Radiology (M.G., M.D.H., J.M.O.), Cumming School of Medicine, University of Calgary, Alberta, Canada.

Axel Rohr (A)

From the IRCCS Humanitas Research Hospital (U.P.); Department of Biomedical Sciences (U.P.), Humanitas University, Milan, Italy; Calgary Stroke Program (U.P., S.B., A.S., A.M.D., M.D.H.), Departments of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Alberta, Canada; Institute of Radiology (A.S.), Cantonal Hospital Münsterlingen, Switzerland; University of British Columbia (A.R.), Vancouver, Canada; Royal Adelaide Hospital (T.J.K.), Adelaide, Australia; Wellstar Health Systems (R.G.), Kennestone Hospital, Marietta, GA; Department of Neurology (G.T.) and Department of Neuroradiology (G.T.), University Medical Center Hamburg-Eppendorf, Germany; University College of Medicine (J.H.H.), Seoul, South Korea; and Department of Radiology (M.G., M.D.H., J.M.O.), Cumming School of Medicine, University of Calgary, Alberta, Canada.

Timothy J Kleinig (TJ)

From the IRCCS Humanitas Research Hospital (U.P.); Department of Biomedical Sciences (U.P.), Humanitas University, Milan, Italy; Calgary Stroke Program (U.P., S.B., A.S., A.M.D., M.D.H.), Departments of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Alberta, Canada; Institute of Radiology (A.S.), Cantonal Hospital Münsterlingen, Switzerland; University of British Columbia (A.R.), Vancouver, Canada; Royal Adelaide Hospital (T.J.K.), Adelaide, Australia; Wellstar Health Systems (R.G.), Kennestone Hospital, Marietta, GA; Department of Neurology (G.T.) and Department of Neuroradiology (G.T.), University Medical Center Hamburg-Eppendorf, Germany; University College of Medicine (J.H.H.), Seoul, South Korea; and Department of Radiology (M.G., M.D.H., J.M.O.), Cumming School of Medicine, University of Calgary, Alberta, Canada.
ORCID: 0000-0003-4430-3276

Rishi Gupta (R)

From the IRCCS Humanitas Research Hospital (U.P.); Department of Biomedical Sciences (U.P.), Humanitas University, Milan, Italy; Calgary Stroke Program (U.P., S.B., A.S., A.M.D., M.D.H.), Departments of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Alberta, Canada; Institute of Radiology (A.S.), Cantonal Hospital Münsterlingen, Switzerland; University of British Columbia (A.R.), Vancouver, Canada; Royal Adelaide Hospital (T.J.K.), Adelaide, Australia; Wellstar Health Systems (R.G.), Kennestone Hospital, Marietta, GA; Department of Neurology (G.T.) and Department of Neuroradiology (G.T.), University Medical Center Hamburg-Eppendorf, Germany; University College of Medicine (J.H.H.), Seoul, South Korea; and Department of Radiology (M.G., M.D.H., J.M.O.), Cumming School of Medicine, University of Calgary, Alberta, Canada.

Götz Thomalla (G)

From the IRCCS Humanitas Research Hospital (U.P.); Department of Biomedical Sciences (U.P.), Humanitas University, Milan, Italy; Calgary Stroke Program (U.P., S.B., A.S., A.M.D., M.D.H.), Departments of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Alberta, Canada; Institute of Radiology (A.S.), Cantonal Hospital Münsterlingen, Switzerland; University of British Columbia (A.R.), Vancouver, Canada; Royal Adelaide Hospital (T.J.K.), Adelaide, Australia; Wellstar Health Systems (R.G.), Kennestone Hospital, Marietta, GA; Department of Neurology (G.T.) and Department of Neuroradiology (G.T.), University Medical Center Hamburg-Eppendorf, Germany; University College of Medicine (J.H.H.), Seoul, South Korea; and Department of Radiology (M.G., M.D.H., J.M.O.), Cumming School of Medicine, University of Calgary, Alberta, Canada.
ORCID: 0000-0002-4785-1449

Ji Hoe Heo (JH)

From the IRCCS Humanitas Research Hospital (U.P.); Department of Biomedical Sciences (U.P.), Humanitas University, Milan, Italy; Calgary Stroke Program (U.P., S.B., A.S., A.M.D., M.D.H.), Departments of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Alberta, Canada; Institute of Radiology (A.S.), Cantonal Hospital Münsterlingen, Switzerland; University of British Columbia (A.R.), Vancouver, Canada; Royal Adelaide Hospital (T.J.K.), Adelaide, Australia; Wellstar Health Systems (R.G.), Kennestone Hospital, Marietta, GA; Department of Neurology (G.T.) and Department of Neuroradiology (G.T.), University Medical Center Hamburg-Eppendorf, Germany; University College of Medicine (J.H.H.), Seoul, South Korea; and Department of Radiology (M.G., M.D.H., J.M.O.), Cumming School of Medicine, University of Calgary, Alberta, Canada.
ORCID: 0000-0001-9898-3321

Mayank Goyal (M)

From the IRCCS Humanitas Research Hospital (U.P.); Department of Biomedical Sciences (U.P.), Humanitas University, Milan, Italy; Calgary Stroke Program (U.P., S.B., A.S., A.M.D., M.D.H.), Departments of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Alberta, Canada; Institute of Radiology (A.S.), Cantonal Hospital Münsterlingen, Switzerland; University of British Columbia (A.R.), Vancouver, Canada; Royal Adelaide Hospital (T.J.K.), Adelaide, Australia; Wellstar Health Systems (R.G.), Kennestone Hospital, Marietta, GA; Department of Neurology (G.T.) and Department of Neuroradiology (G.T.), University Medical Center Hamburg-Eppendorf, Germany; University College of Medicine (J.H.H.), Seoul, South Korea; and Department of Radiology (M.G., M.D.H., J.M.O.), Cumming School of Medicine, University of Calgary, Alberta, Canada.
ORCID: 0000-0001-9060-2109

Andrew M Demchuk (AM)

From the IRCCS Humanitas Research Hospital (U.P.); Department of Biomedical Sciences (U.P.), Humanitas University, Milan, Italy; Calgary Stroke Program (U.P., S.B., A.S., A.M.D., M.D.H.), Departments of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Alberta, Canada; Institute of Radiology (A.S.), Cantonal Hospital Münsterlingen, Switzerland; University of British Columbia (A.R.), Vancouver, Canada; Royal Adelaide Hospital (T.J.K.), Adelaide, Australia; Wellstar Health Systems (R.G.), Kennestone Hospital, Marietta, GA; Department of Neurology (G.T.) and Department of Neuroradiology (G.T.), University Medical Center Hamburg-Eppendorf, Germany; University College of Medicine (J.H.H.), Seoul, South Korea; and Department of Radiology (M.G., M.D.H., J.M.O.), Cumming School of Medicine, University of Calgary, Alberta, Canada.
ORCID: 0000-0002-4930-7789

Michael D Hill (MD)

From the IRCCS Humanitas Research Hospital (U.P.); Department of Biomedical Sciences (U.P.), Humanitas University, Milan, Italy; Calgary Stroke Program (U.P., S.B., A.S., A.M.D., M.D.H.), Departments of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Alberta, Canada; Institute of Radiology (A.S.), Cantonal Hospital Münsterlingen, Switzerland; University of British Columbia (A.R.), Vancouver, Canada; Royal Adelaide Hospital (T.J.K.), Adelaide, Australia; Wellstar Health Systems (R.G.), Kennestone Hospital, Marietta, GA; Department of Neurology (G.T.) and Department of Neuroradiology (G.T.), University Medical Center Hamburg-Eppendorf, Germany; University College of Medicine (J.H.H.), Seoul, South Korea; and Department of Radiology (M.G., M.D.H., J.M.O.), Cumming School of Medicine, University of Calgary, Alberta, Canada.
ORCID: 0000-0002-6269-1543

Johanna M Ospel (JM)

From the IRCCS Humanitas Research Hospital (U.P.); Department of Biomedical Sciences (U.P.), Humanitas University, Milan, Italy; Calgary Stroke Program (U.P., S.B., A.S., A.M.D., M.D.H.), Departments of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Alberta, Canada; Institute of Radiology (A.S.), Cantonal Hospital Münsterlingen, Switzerland; University of British Columbia (A.R.), Vancouver, Canada; Royal Adelaide Hospital (T.J.K.), Adelaide, Australia; Wellstar Health Systems (R.G.), Kennestone Hospital, Marietta, GA; Department of Neurology (G.T.) and Department of Neuroradiology (G.T.), University Medical Center Hamburg-Eppendorf, Germany; University College of Medicine (J.H.H.), Seoul, South Korea; and Department of Radiology (M.G., M.D.H., J.M.O.), Cumming School of Medicine, University of Calgary, Alberta, Canada.
ORCID: 0000-0003-0029-6764
From the IRCCS Humanitas Research Hospital (U.P.); Department of Biomedical Sciences (U.P.), Humanitas University, Milan, Italy; Calgary Stroke Program (U.P., S.B., A.S., A.M.D., M.D.H.), Departments of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Alberta, Canada; Institute of Radiology (A.S.), Cantonal Hospital Münsterlingen, Switzerland; University of British Columbia (A.R.), Vancouver, Canada; Royal Adelaide Hospital (T.J.K.), Adelaide, Australia; Wellstar Health Systems (R.G.), Kennestone Hospital, Marietta, GA; Department of Neurology (G.T.) and Department of Neuroradiology (G.T.), University Medical Center Hamburg-Eppendorf, Germany; University College of Medicine (J.H.H.), Seoul, South Korea; and Department of Radiology (M.G., M.D.H., J.M.O.), Cumming School of Medicine, University of Calgary, Alberta, Canada.

Articles similaires

[Redispensing of expensive oral anticancer medicines: a practical application].

Lisanne N van Merendonk, Kübra Akgöl, Bastiaan Nuijen
1.00
Humans Antineoplastic Agents Administration, Oral Drug Costs Counterfeit Drugs

Smoking Cessation and Incident Cardiovascular Disease.

Jun Hwan Cho, Seung Yong Shin, Hoseob Kim et al.
1.00
Humans Male Smoking Cessation Cardiovascular Diseases Female

Evaluation of Low-Value Services Across Major Medicare Advantage Insurers and Traditional Medicare.

Ciara Duggan, Adam L Beckman, Ishani Ganguli et al.
1.00
Humans United States Aged Cross-Sectional Studies Medicare Part C

Effectiveness of Virtual Yoga for Chronic Low Back Pain: A Randomized Clinical Trial.

Hallie Tankha, Devyn Gaskins, Amanda Shallcross et al.
1.00
Humans Yoga Low Back Pain Female Male

Classifications MeSH

questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Effect of Hemoglobin and Blood Glucose Levels...
questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Sujet âgé › Effect of Hemoglobin and Blood Glucose Levels...
questionsmedicales.fr › Maladies cardiovasculaires › Maladies vasculaires › Angiopathies intracrâniennes › Accident vasculaire cérébral › Accident vasculaire cérébral ischémique › Effect of Hemoglobin and Blood Glucose Levels...
questionsmedicales.fr › Glucides › Sucres › Oses › Hexose › Glucose › Glycémie › Effect of Hemoglobin and Blood Glucose Levels...
questionsmedicales.fr › Acides aminés, peptides et protéines › Protéines › Hémoprotéines › Globines › Hémoglobines › Effect of Hemoglobin and Blood Glucose Levels...
questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Adulte d'âge moyen › Effect of Hemoglobin and Blood Glucose Levels...
questionsmedicales.fr › Diagnostic › Techniques et procédures diagnostiques › Imagerie diagnostique › Tomographie › Tomographie à rayons X › Tomodensitométrie › Effect of Hemoglobin and Blood Glucose Levels...
questionsmedicales.fr › Phénomènes physiologiques respiratoires et circulatoires › Phénomènes physiologiques cardiovasculaires › Circulation sanguine › Circulation cérébrovasculaire › Effect of Hemoglobin and Blood Glucose Levels...
questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Sujet âgé › Sujet âgé de 80 ans ou plus › Effect of Hemoglobin and Blood Glucose Levels...
questionsmedicales.fr › Hémopathies et maladies lymphatiques › Hémopathies › Anémie › Effect of Hemoglobin and Blood Glucose Levels...
questionsmedicales.fr › Procédures de chirurgie opératoire › Procédures de chirurgie cardiovasculaire › Procédures de chirurgie vasculaire › Thrombectomie › Effect of Hemoglobin and Blood Glucose Levels...
questionsmedicales.fr › Maladies cardiovasculaires › Maladies vasculaires › Angiopathies intracrâniennes › Encéphalopathie ischémique › Effect of Hemoglobin and Blood Glucose Levels...
questionsmedicales.fr › Diagnostic › Techniques et procédures diagnostiques › Techniques de diagnostic radioisotopique › Scintigraphie › Imagerie de perfusion › Effect of Hemoglobin and Blood Glucose Levels...
questionsmedicales.fr › Maladies métaboliques et nutritionnelles › Maladies métaboliques › Troubles du métabolisme du glucose › Hyperglycémie › Effect of Hemoglobin and Blood Glucose Levels...