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Updated: Oct 8, 2025
A Mouse Model of Hemorrhagic Transformation Induced by Acute Hyperglycemia Combined with Transient Focal Ischemia
Published on: November 15, 2024
Initial Stress Hyperglycemia Is Associated With Malignant Cerebral Edema, Hemorrhage, and Poor Functional Outcome
Gregory J Cannarsa1, Aaron P Wessell1, Timothy Chryssikos1
1Department of Neurosurgery, University of Maryland Medical Center, Baltimore, Maryland, USA.
Background:
Malignant cerebral edema (MCE) and intracranial hemorrhage (ICH) are associated with poor neurological outcomes despite revascularization after mechanical thrombectomy (MT). The factors associated with the development of MCE and ICH after MT are not well understood.
Objective:
To determine periprocedural factors associated with MCE, ICH, and poor functional outcome.
Methods:
We retrospectively analyzed anterior cerebral circulation large vessel occlusion cases that underwent MT from 2012 to 2019 at a single Comprehensive Stroke Center. Multivariate logistic regression analyses were performed to determine significant predictors of MCE, ICH, and poor functional outcome (modified Rankin Scale, 3-6) at 90 d.
Results:
Four hundred patients were included. Significant independent predictors of MCE after MT included initial stress glucose ratio (iSGR) (odds ratio [OR], 14.26; 95% CI, 3.82-53.26; P < .001), National Institutes of Health Stroke Scale (NIHSS) (OR, 1.10; 95% CI, 1.03-1.18; P = .008), internal carotid artery compared with M1 or M2 occlusion, and absence of successful revascularization (OR, 0.16; 95% CI, 0.06-0.44; P < .001). Significant independent predictors of poor functional outcome included MCE (OR, 7.47; 95% CI, 2.20-25.37; P = .001), iSGR (OR, 5.15; 95% CI, 1.82-14.53; P = .002), ICH (OR, 4.77; 95% CI, 1.20-18.69; P = .024), NIHSS (OR, 1.10; 95% CI, 1.05-1.16; P < .001), age (OR, 1.04; 95% CI, 1.03-1.07; P < .001), and thrombolysis in cerebral infarction 2C/3 recanalization (OR, 0.12; 95% CI, 0.05-0.29; P < .001).
Conclusion:
Elevated iSGR significantly increases the risk of MCE and ICH and is an independent predictor of poor functional outcome. Thrombolysis in cerebral infarction 2C/3 revascularization is associated with reduced risk of MCE, ICH, and poor functional outcome. Whether stress hyperglycemia represents a modifiable risk factor is uncertain, and further investigation is warranted.
Insights
High initial stress glucose ratio (iSGR) significantly increases the risk of malignant cerebral edema (MCE) and intracranial hemorrhage (ICH) after mechanical thrombectomy (MT). Successful revascularization reduces these risks and improves functional outcomes.
Area of Science:
- Neurology
- Neurosurgery
- Critical Care Medicine
Background:
- Malignant cerebral edema (MCE) and intracranial hemorrhage (ICH) are serious complications following mechanical thrombectomy (MT) for stroke, often leading to poor neurological outcomes.
- Factors contributing to MCE and ICH post-MT require further elucidation to improve patient management.
Purpose of the Study:
- To identify periprocedural factors predicting the development of MCE and ICH.
- To determine predictors of poor functional outcomes after MT.
Main Methods:
- Retrospective analysis of 400 anterior circulation large vessel occlusion cases undergoing MT (2012-2019).
- Multivariate logistic regression used to identify significant predictors of MCE, ICH, and 90-day functional outcomes (modified Rankin Scale 3-6).
Main Results:
- Initial stress glucose ratio (iSGR) and higher NIHSS scores were significant predictors of MCE.
- MCE, ICH, elevated iSGR, higher NIHSS, and older age predicted poor functional outcomes.
- Successful revascularization (TICI 2C/3) was associated with a reduced risk of MCE, ICH, and poor outcomes.
Conclusions:
- Elevated iSGR is a significant independent predictor of MCE, ICH, and poor functional outcomes post-MT.
- Successful revascularization is linked to better outcomes and reduced complication rates.
- The potential for stress hyperglycemia to be a modifiable risk factor warrants further investigation.
