WHOM is the person responsible for shepherding
this through human clinical studies to a translational protocol? With
no one identified it will fall thru the cracks like the thousands of
other research studies that showed promise.
A Pooled-Data Meta-Analysis
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Abstract
Background and Purpose—
Hyperglycemia
is a negative prognostic factor after acute ischemic stroke but is not
known whether glucose is associated with the effects of endovascular
thrombectomy (EVT) in patients with large-vessel stroke. In a
pooled-data meta-analysis, we analyzed whether serum glucose is a
treatment modifier of the efficacy of EVT in acute stroke.
Methods—
Seven
randomized trials compared EVT with standard care between 2010 and 2017
(HERMES Collaboration [highly effective reperfusion using multiple
endovascular devices]). One thousand seven hundred and sixty-four
patients with large-vessel stroke were allocated to EVT (n=871) or
standard care (n=893). Measurements included blood glucose on admission
and functional outcome (modified Rankin Scale range, 0–6; lower scores
indicating less disability) at 3 months. The primary analysis evaluated
whether glucose modified the effect of EVT over standard care on
functional outcome, using ordinal logistic regression to test the
interaction between treatment and glucose level.
Results—
Median
(interquartile range) serum glucose on admission was 120 (104–140)
mg/dL (6.6 mmol/L [5.7–7.7] mmol/L). EVT was better than standard care
in the overall pooled-data analysis adjusted common odds ratio (acOR),
2.00 (95% CI, 1.69–2.38); however, lower glucose levels were associated
with greater effects of EVT over standard care. The interaction was
nonlinear such that significant interactions were found in subgroups of
patients split at glucose < or >90 mg/dL (5.0 mmol/L; P=0.019
for interaction; acOR, 3.81; 95% CI, 1.73–8.41 for patients < 90
mg/dL versus 1.83; 95% CI, 1.53–2.19 for patients >90 mg/dL), and
glucose < or >100 mg/dL (5.5 mmol/L; P=0.004 for
interaction; acOR, 3.17; 95% CI, 2.04–4.93 versus acOR, 1.72; 95% CI,
1.42–2.08) but not between subgroups above these levels of glucose.
Conclusions—
EVT
improved stroke outcomes compared with standard treatment regardless of
glucose levels, but the treatment effects were larger at lower glucose
levels, with significant interaction effects persisting up to 90 to 100
mg/dL (5.0–5.5 mmol/L). Whether tight control of glucose improves the
efficacy of EVT after large-vessel stroke warrants appropriate testing.
Footnotes
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