Intravenous Glibenclamide Reduces Lesional Water Uptake in Large Hemispheric Infarction
Pongpat Vorasayan1,2, Matthew B Bevers3, Lauren A Beslow4,5
1From the Division of Neurocritical Care and Center for Genomic Medicine, Massachusetts General Hospital, Boston (P.V., W.T.K.).
Stroke
|September 21, 2019
Summary
Intravenous glibenclamide significantly reduced brain edema and mass effect in stroke patients. This study highlights net water uptake (NWU) as a key biomarker for tracking and potentially modifying ischemic brain swelling.
Area of Science:
- Neurology
- Radiology
- Pharmacology
Background:
- Prior research established a link between CT radiodensity and brain edema in stroke lesions.
- Ischemic stroke leads to significant brain water accumulation, contributing to secondary brain injury.
Purpose of the Study:
- To evaluate the efficacy of intravenous glibenclamide (BIIB093) in reducing ischemic brain water uptake.
- To quantify net water uptake (NWU) and midline shift (MLS) in stroke patients treated with glibenclamide.
Main Methods:
- Post hoc analysis of the phase 2 GAMES-RP trial involving 264 patients.
- Serial CT scans analyzed for quantitative changes in radiodensity (NWU) and MLS.
- Repeated-measures mixed-effects models used to assess glibenclamide's impact on NWU and MLS.
Main Results:
- Greater NWU correlated with increased MLS (P<0.001).
- Intravenous glibenclamide treatment significantly reduced NWU (P=0.016) and MLS (P=0.016).
- Glibenclamide decreased both gray and white matter water uptake, with gray matter NWU contributing more to MLS.
Conclusions:
- Intravenous glibenclamide effectively reduced water accumulation and mass effect in large hemispheric infarction.
- Net water uptake (NWU) is a quantifiable and modifiable biomarker for ischemic brain edema.
- Findings support glibenclamide's potential as a therapeutic agent for reducing stroke-related brain swelling.
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