Treatment of hyperglycemia in ischemic stroke (THIS): a randomized pilot trial.

Abstract:

BACKGROUND AND PURPOSE:Hyperglycemia may worsen brain injury during acute cerebral infarction. We tested the feasibility and tolerability of aggressive hyperglycemia correction with intravenous insulin compared with usual care during acute cerebral infarction. METHODS:We conducted a randomized, multicenter, blinded pilot trial for patients with cerebral infarction within 12 hours after onset, a baseline glucose value >or=8.3 mmol/L (>or=150 mg/dL), and a National Institutes of Health Stroke Scale score of 3 to 22. Patients were randomized 2:1 to aggressive treatment with continuous intravenous insulin or subcutaneous insulin QID as needed (usual care). Target glucose levels were <7.2 mmol/L (<130 mg/dL) in the aggressive-treatment group and <11.1 mmol/L (<200 mg/dL) in the usual-care group. Glucose was monitored every 1 to 2 hours, and the protocol treatments continued for up to 72 hours. Final clinical outcomes were assessed at 3 months. RESULTS:We randomized 46 patients (31 to aggressive treatment and 15 to usual care). All patients in the aggressive-treatment group and 11 (73%) in the usual-care group had diabetes (P=0.008). Glucose levels were significantly lower in the aggressive-treatment group throughout protocol treatment (7.4 vs 10.5 mmol/L [133 vs 190 mg/dL], P<0.001). Hypoglycemia <3.3 mmol/L (<60 mg/dL) occurred only in the aggressive-treatment group (11 patients, 35%), 4 (13%) of whom had brief symptoms, including only 1 (3%) neurologic. Final clinical outcomes were nonsignificantly better in the aggressive-treatment group. CONCLUSIONS:The intravenous insulin protocol corrected hyperglycemia during acute cerebral infarction significantly better than usual care without major adverse events and should be investigated in a clinical efficacy trial.

journal_name

Stroke

journal_title

Stroke

authors

Bruno A,Kent TA,Coull BM,Shankar RR,Saha C,Becker KJ,Kissela BM,Williams LS

doi

10.1161/STROKEAHA.107.493544

subject

Has Abstract

pub_date

2008-02-01 00:00:00

pages

384-9

issue

2

eissn

0039-2499

issn

1524-4628

pii

STROKEAHA.107.493544

journal_volume

39

pub_type

杂志文章,多中心研究,随机对照试验

相关文献

STROKE文献大全
  • Minimally invasive surgery for spontaneous supratentorial intracerebral hemorrhage: a meta-analysis of randomized controlled trials.

    abstract:BACKGROUND AND PURPOSE:There has been a nonstandard surgical procedure and extensive international controversy in minimally invasive surgery (MIS) for the management of spontaneous supratentorial intracerebral hemorrhage. This meta-analysis assessed the effectiveness of MIS as compared with other treatment options, inc...

    journal_title:Stroke

    pub_type: 杂志文章,meta分析

    doi:10.1161/STROKEAHA.112.667535

    authors: Zhou X,Chen J,Li Q,Ren G,Yao G,Liu M,Dong Q,Guo J,Li L,Guo J,Xie P

    更新日期:2012-11-01 00:00:00

  • Genomics of preconditioning.

    abstract::Brief episodes of ischemia can protect against subsequent damaging ischemic events; however, the molecular mechanisms responsible for protection are poorly understood. Identifying genes involved in this process could provide insight into cell survival and treatment of stroke. We developed a murine model of ischemic pr...

    journal_title:Stroke

    pub_type: 杂志文章

    doi:10.1161/01.STR.0000143735.89281.bb

    authors: Stenzel-Poore MP,Stevens SL,Simon RP

    更新日期:2004-11-01 00:00:00

  • Outcomes of intravenous recombinant tissue plasminogen activator therapy according to gender: a clinical registry study and systematic review.

    abstract:BACKGROUND AND PURPOSE:The natural history of stroke is worse in women than in men. Controversial data have been published on the efficacy of thrombolysis with recombinant tissue plasminogen activator (rtPA) according to gender. We evaluated gender differences in the efficacy and safety outcomes of intravenous rtPA usi...

    journal_title:Stroke

    pub_type: 杂志文章,评审

    doi:10.1161/STROKEAHA.108.546325

    authors: Meseguer E,Mazighi M,Labreuche J,Arnaiz C,Cabrejo L,Slaoui T,Guidoux C,Olivot JM,Abboud H,Lapergue B,Raphaeli G,Klein IF,Lavallée PC,Amarenco P

    更新日期:2009-06-01 00:00:00

  • Acute effects of isovolemic hemodilution with crystalloids in a canine model of focal cerebral ischemia.

    abstract::We used 44 splenectomized dogs to study the effects of isovolemic hemodilution with a crystalloid solution. The dogs were randomly divided into a hemodilution and a control group. In each group, 17 dogs were subjected to 6 hours of internal carotid and middle cerebral artery occlusion, and five dogs received sham oper...

    journal_title:Stroke

    pub_type: 杂志文章

    doi:10.1161/01.str.20.4.534

    authors: Hyodo A,Heros RC,Tu YK,Ogilvy C,Graichen R,Lagree K,Korosue K

    更新日期:1989-04-01 00:00:00

  • Medial medullary infarction from fibrocartilaginous embolism to the anterior spinal artery.

    abstract::A previously healthy young woman presented with sudden onset of quadriplegia, anesthesia below the C3 dermatome, respiratory paralysis, vertical nystagmus, ocular bobbing and cortical blindness. After partial resolution of the latter deficits, she remained quadriplegic, with a C3 level of anesthesia, and in respirator...

    journal_title:Stroke

    pub_type: 杂志文章

    doi:10.1161/01.str.14.3.413

    authors: Kase CS,Varakis JN,Stafford JR,Mohr JP

    更新日期:1983-05-01 00:00:00

  • Intra- and interrater reliability of ischemic lesion volume measurements on diffusion-weighted, mean transit time and fluid-attenuated inversion recovery MRI.

    abstract:BACKGROUND AND PURPOSE:We investigated the intra- and interrater reliability of ischemic lesion volumes measurements assessed by different MRI sequences at various times from onset. METHODS:Ischemic lesion volumes were measured for intrarater reliability using diffusion-weighted (DWI), mean transit time (MTT) perfusio...

    journal_title:Stroke

    pub_type: 杂志文章

    doi:10.1161/01.STR.0000249416.77132.1a

    authors: Luby M,Bykowski JL,Schellinger PD,Merino JG,Warach S

    更新日期:2006-12-01 00:00:00

  • Contribution of atrial fibrillation to incidence and outcome of ischemic stroke: results from a population-based study.

    abstract:BACKGROUND AND PURPOSE:Atrial fibrillation (AF) is a major risk factor for ischemic stroke and its prevalence increases steeply with age. Population-based data on its influence on stroke outcome are scarce. METHODS:We evaluated the prevalence of AF and its influence on prognosis in patients with a first-ever ischemic ...

    journal_title:Stroke

    pub_type: 杂志文章

    doi:10.1161/01.STR.0000166053.83476.4a

    authors: Marini C,De Santis F,Sacco S,Russo T,Olivieri L,Totaro R,Carolei A

    更新日期:2005-06-01 00:00:00

  • Distributional impact of brain microbleeds on global cognitive function in adults without neurological disorder.

    abstract:BACKGROUND AND PURPOSE:Brain microbleeds (MBs) are considered to be associated with cognitive decline and can be pathologically and topographically classified as cerebral amyloid angiopathy-related (located in lobar regions) and hypertensive microangiopathy-related (located in deep regions). We examined whether differe...

    journal_title:Stroke

    pub_type: 杂志文章

    doi:10.1161/STROKEAHA.111.647065

    authors: Yakushiji Y,Noguchi T,Hara M,Nishihara M,Eriguchi M,Nanri Y,Nishiyama M,Hirotsu T,Nakajima J,Kuroda Y,Hara H

    更新日期:2012-07-01 00:00:00

  • Focal ischemia enhances choline output and decreases acetylcholine output from rat cerebral cortex.

    abstract::Choline concentration is rate limiting in the synthesis of acetylcholine. There is a negative arteriovenous difference for choline concentration across the brain, indicating the steady output of choline from this organ. Cerebral ischemia may increase extracellular choline concentration by interfering with its removal ...

    journal_title:Stroke

    pub_type: 杂志文章

    doi:10.1161/01.str.20.1.92

    authors: Scremin OU,Jenden DJ

    更新日期:1989-01-01 00:00:00

  • Extent of acute hydrocephalus after aneurysmal subarachnoid hemorrhage as a risk factor for delayed cerebral infarction.

    abstract:BACKGROUND AND PURPOSE:Delayed cerebral infarction (DCI) is an important cause of poor outcome after subarachnoid hemorrhage. Cerebral perfusion is a predictor for DCI. Because acute hydrocephalus may impair cerebral perfusion, we evaluated the predictive value of the extent of acute hydrocephalus on the development of...

    journal_title:Stroke

    pub_type: 杂志文章

    doi:10.1161/STROKEAHA.107.484220

    authors: Bakker AM,Dorhout Mees SM,Algra A,Rinkel GJ

    更新日期:2007-09-01 00:00:00

  • Characteristics of blood pressure profiles as predictors of long-term outcome after acute ischemic stroke.

    abstract:BACKGROUND AND PURPOSE:Most patients have elevated blood pressure (BP) in the early phase after an acute ischemic stroke. Mechanism and effects of this BP elevation are not well understood. The benefits of intervention by lowering the initial BP or waiting for spontaneous return to normal values remain debated. We stud...

    journal_title:Stroke

    pub_type: 杂志文章,多中心研究,随机对照试验

    doi:10.1161/01.STR.0000189998.74892.24

    authors: Yong M,Diener HC,Kaste M,Mau J

    更新日期:2005-12-01 00:00:00

  • Absolute quantitation of diffusion constants in human stroke.

    abstract:BACKGROUND AND PURPOSE:Animal studies have shown that MR diffusion imaging can outline acute ischemic regions before irreversible damage (infarction) occurs. To study evolution of ischemic lesions in humans, it is therefore important to quantify absolute diffusion constants (D values), but quantitation has not been rep...

    journal_title:Stroke

    pub_type: 杂志文章

    doi:10.1161/01.str.28.3.483

    authors: Uluğ AM,Beauchamp N Jr,Bryan RN,van Zijl PC

    更新日期:1997-03-01 00:00:00

  • Complex plaques in the proximal descending aorta: an underestimated embolic source of stroke.

    abstract:BACKGROUND AND PURPOSE:To investigate the incidence of retrograde flow from complex plaques (> or =4-mm-thick, ulcerated, or superimposed thrombi) of the descending aorta (DAo) and its potential role in embolic stroke. METHODS:Ninety-four consecutive acute stroke patients with aortic plaques > or =3-mm-thick in transe...

    journal_title:Stroke

    pub_type: 杂志文章

    doi:10.1161/STROKEAHA.109.577775

    authors: Harloff A,Simon J,Brendecke S,Assefa D,Helbing T,Frydrychowicz A,Weber J,Olschewski M,Strecker C,Hennig J,Weiller C,Markl M

    更新日期:2010-06-01 00:00:00

  • Retinal microvascular signs may provide clues to the underlying vasculopathy in patients with deep intracerebral hemorrhage.

    abstract:BACKGROUND AND PURPOSE:Deep intracerebral hemorrhage (ICH) and lacunar infarcts are the result of small vessel disease, whereas nonlacunar infarcts are often caused by large artery atherosclerosis or cardiac embolism. We hypothesized that patients with deep ICH and lacunar infarcts have similar retinal microvascular si...

    journal_title:Stroke

    pub_type: 杂志文章,多中心研究

    doi:10.1161/STROKEAHA.109.569764

    authors: Baker ML,Hand PJ,Liew G,Wong TY,Rochtchina E,Mitchell P,Lindley RI,Hankey GJ,Wang JJ,Multi-Centre Retinal Stroke Study Group.

    更新日期:2010-04-01 00:00:00

  • High-resolution emboli detection and differentiation by characteristic postembolic spectral patterns.

    abstract:BACKGROUND AND PURPOSE:High-intensity transient signals (HITS) detected by transcranial Doppler ultrasonography correspond to microemboli in intracranial arteries. The purpose of this study was to develop new diagnostic criteria for the differentiation of these microembolic signals from artifact, based on a high-resolu...

    journal_title:Stroke

    pub_type: 杂志文章

    doi:10.1161/01.str.29.3.668

    authors: Ries F,Tiemann K,Pohl C,Bauer C,Mundo M,Becher H

    更新日期:1998-03-01 00:00:00

  • Hemoglobin-induced cytotoxicity in rat cerebral cortical neurons: caspase activation and oxidative stress.

    abstract:BACKGROUND AND PURPOSE:Apoptotic-like pathways may contribute to brain cell death after intracerebral hemorrhage. In this study, we used a simplified in vitro model of hemoglobin neurotoxicity to map the caspase cascades involved and to document the role of oxidative stress. METHODS:Primary neuronal cultures were obta...

    journal_title:Stroke

    pub_type: 杂志文章

    doi:10.1161/01.str.0000020121.41527.5d

    authors: Wang X,Mori T,Sumii T,Lo EH

    更新日期:2002-07-01 00:00:00

  • Effect of baseline CT scan appearance and time to recanalization on clinical outcomes in endovascular thrombectomy of acute ischemic strokes.

    abstract:BACKGROUND AND PURPOSE:the Penumbra Pivotal Stroke Trial reported a 25% good outcome (modified Rankin scale score ≤ 2) despite an 81% recanalization rate. We evaluated the association of a favorable initial noncontrast CT and a short time to recanalization in predicting good outcome. METHODS:data were from the Penumbr...

    journal_title:Stroke

    pub_type: 临床试验,杂志文章,多中心研究

    doi:10.1161/STROKEAHA.110.594481

    authors: Goyal M,Menon BK,Coutts SB,Hill MD,Demchuk AM,Penumbra Pivotal Stroke Trial Investigators, Calgary Stroke Program, and the Seaman MR Research Center.

    更新日期:2011-01-01 00:00:00

  • Extracellular concentrations of non-transmitter amino acids in peri-infarct tissue of patients predict malignant middle cerebral artery infarction.

    abstract:BACKGROUND AND PURPOSE:Space-occupying brain edema is a life-threatening complication in patients with large middle cerebral artery (MCA) infarction. To determine predictors of this detrimental process, we investigated alterations of extracellular non-transmitter amino acid concentrations in peri-infarct tissue. METHO...

    journal_title:Stroke

    pub_type: 临床试验,杂志文章

    doi:10.1161/01.STR.0000100158.51986.EB

    authors: Bosche B,Dohmen C,Graf R,Neveling M,Staub F,Kracht L,Sobesky J,Lehnhardt FG,Heiss WD

    更新日期:2003-12-01 00:00:00

  • Predicting long-term independency in activities of daily living after middle cerebral artery stroke: does information from MRI have added predictive value compared with clinical information?

    abstract:BACKGROUND AND PURPOSE:To investigate whether neuroimaging information has added predictive value compared with clinical information for independency in activities of daily living (ADL) 1 year after stroke. METHODS:Seventy-five first-ever middle cerebral artery stroke survivors were evaluated in logistic regression an...

    journal_title:Stroke

    pub_type: 杂志文章

    doi:10.1161/01.STR.0000206462.09410.6f

    authors: Schiemanck SK,Kwakkel G,Post MW,Kappelle LJ,Prevo AJ

    更新日期:2006-04-01 00:00:00

  • Is there a direct link between cerebrovascular activity and cerebrospinal fluid pressure-volume compensation?

    abstract:BACKGROUND AND PURPOSE:Cerebral blood flow is coupled to brain metabolism by means of active modulation of cerebrovascular resistance. This homeostatic vasogenic activity is reflected in slow waves of cerebral blood flow velocities (FV) which can also be detected in intracranial pressure (ICP). However, effects of incr...

    journal_title:Stroke

    pub_type: 杂志文章

    doi:10.1161/STROKEAHA.107.485847

    authors: Haubrich C,Czosnyka Z,Lavinio A,Smielewski P,Diehl RR,Pickard JD,Czosnyka M

    更新日期:2007-10-01 00:00:00

  • Intracarotid saline infusion improves outcome from incomplete ischemia in rats.

    abstract::Previous studies suggest that rheological changes associated with ischemia may produce postischemic hypoperfusion. We tested whether intracarotid or intravenous infusions of saline improve neurological outcome from incomplete cerebral ischemia in rats. Rats were anesthetized with 1.4% isoflurane in air, and ischemia w...

    journal_title:Stroke

    pub_type: 杂志文章

    doi:10.1161/01.str.22.6.797

    authors: Hoffman WE,Ferguson L,Thomas C,Albrecht RF

    更新日期:1991-06-01 00:00:00

  • Factors influencing the detection of early CT signs of cerebral ischemia: an internet-based, international multiobserver study.

    abstract:BACKGROUND AND PURPOSE:Early CT signs of cerebral ischemia are subtle. Little is known of which factors influence the detection of infarct signs. We compared neuroradiologists' scan readings with those of other specialists involved in the care of stroke patients. METHODS:We used the Internet to show 63 CT scans, all a...

    journal_title:Stroke

    pub_type: 杂志文章,多中心研究

    doi:10.1161/01.STR.0000259715.53166.25

    authors: Wardlaw JM,Farrall AJ,Perry D,von Kummer R,Mielke O,Moulin T,Ciccone A,Hill M,Acute Cerebral CT Evaluation of Stroke Study (ACCESS) Study Group.

    更新日期:2007-04-01 00:00:00

  • Leukoaraiosis correlates with cerebral hypoperfusion in vascular dementia.

    abstract::Leukoaraiosis quantified by computerized densitometric measurements of reduced Hounsfield numbers was correlated with local cerebral blood flow on the same computed tomographic images of 35 patients with multi-infarct dementia and 16 age-matched elderly normal volunteers. The ratio for area of frontal leukoaraiosis to...

    journal_title:Stroke

    pub_type: 杂志文章

    doi:10.1161/01.str.22.5.609

    authors: Kawamura J,Meyer JS,Terayama Y,Weathers S

    更新日期:1991-05-01 00:00:00

  • Immediate changes in stroke lesion volumes post thrombolysis predict clinical outcome.

    abstract:BACKGROUND AND PURPOSE:We hypothesize that reversal in diffusion-weighted imaging (DWI) volume at 24 hours predicts favorable clinical outcome only if accompanied by immediate reperfusion. Our aim was to quantify the immediate DWI and mean transit time changes at 2 and 24 hours after intravenous tissue-type plasminogen...

    journal_title:Stroke

    pub_type: 杂志文章

    doi:10.1161/STROKEAHA.114.006082

    authors: Luby M,Warach SJ,Nadareishvili Z,Merino JG

    更新日期:2014-11-01 00:00:00

  • Addition of brain infarction to the ABCD2 Score (ABCD2I): a collaborative analysis of unpublished data on 4574 patients.

    abstract:BACKGROUND AND PURPOSE:The ABCD system was developed to predict early stroke risk after transient ischemic attack. Incorporation of brain imaging findings has been suggested, but reports have used inconsistent methods and been underpowered. We therefore performed an international, multicenter collaborative study of the...

    journal_title:Stroke

    pub_type: 杂志文章,多中心研究

    doi:10.1161/STROKEAHA.110.578971

    authors: Giles MF,Albers GW,Amarenco P,Arsava MM,Asimos A,Ay H,Calvet D,Coutts S,Cucchiara BL,Demchuk AM,Johnston SC,Kelly PJ,Kim AS,Labreuche J,Lavallee PC,Mas JL,Merwick A,Olivot JM,Purroy F,Rosamond WD,Sciolla R,Rothw

    更新日期:2010-09-01 00:00:00

  • Biphasic striatal dopamine release during transient ischemia and reperfusion in gerbils.

    abstract::To clarify the nature of ischemic striatal dopamine release during the earliest periods of neuronal injury, we used chronoamperometry to measure dopamine levels every 60 seconds during various durations of ischemia in 32 gerbils. Catecholamine-selective electrodes were implanted into the brains of anesthetized gerbils...

    journal_title:Stroke

    pub_type: 杂志文章

    doi:10.1161/01.str.22.5.674

    authors: Ahn SS,Blaha CD,Alkire MT,Wood E,Gray-Allan P,Marrocco RT,Moore WS

    更新日期:1991-05-01 00:00:00

  • Interleukin-6 promoter polymorphism modulates the effects of heavy alcohol consumption on early carotid artery atherosclerosis: the Carotid Atherosclerosis Progression Study (CAPS).

    abstract:BACKGROUND AND PURPOSE:A J-shaped relationship has been demonstrated between alcohol and both clinical cardiovascular events and carotid atherosclerosis. A similar J-shaped relationship has been found between alcohol intake and inflammatory markers. If inflammation were on the intermediate causal pathway between alcoho...

    journal_title:Stroke

    pub_type: 杂志文章

    doi:10.1161/01.str.0000053849.09308.b2

    authors: Jerrard-Dunne P,Sitzer M,Risley P,Steckel DA,Buehler A,von Kegler S,Markus HS,Carotid Atherosclerosis Progression Study.

    更新日期:2003-02-01 00:00:00

  • Analysis of the effect of bilateral sympathetic stimulation of cerebral and cephalic blood flow in the dog.

    abstract::Unilateral stimulation of the cervical sympathetic in dogs had no effect on cerebral blood flow (CBF) measured by the venous outflow technique. Since this technique measured CBF from both cerebral hemispheres, small changes induced by unilateral stimulation could have been masked by a large constant CBF measured from ...

    journal_title:Stroke

    pub_type: 杂志文章

    doi:10.1161/01.str.9.1.29

    authors: Barber BJ,Martin JS,Rapela CE

    更新日期:1978-01-01 00:00:00

  • Mild hypothermia after intravenous thrombolysis in patients with acute stroke: a randomized controlled trial.

    abstract:BACKGROUND AND PURPOSE:Hypothermia improves outcome in resuscitated patients and newborns with hypoxic brain injury. We studied the safety and feasibility of mild hypothermia in awake patients with stroke after intravenous thrombolysis. METHODS:Patients were randomized 1:1 to mild hypothermia (35°C) or to standard str...

    journal_title:Stroke

    pub_type: 杂志文章,随机对照试验

    doi:10.1161/STROKEAHA.113.003180

    authors: Piironen K,Tiainen M,Mustanoja S,Kaukonen KM,Meretoja A,Tatlisumak T,Kaste M

    更新日期:2014-02-01 00:00:00

  • Age-related vulnerability to cerebral ischemia in spontaneously hypertensive rats.

    abstract:BACKGROUND AND PURPOSE:We sought to determine the effects of aging on regional cerebral blood flow and ischemic brain damage in transient cerebral ischemia in rats. METHODS:Five adult (5-6 months) and five aged (18-22 months) female spontaneously hypertensive rats were subjected to 20 minutes of bilateral carotid occl...

    journal_title:Stroke

    pub_type: 杂志文章

    doi:10.1161/01.str.22.11.1414

    authors: Yao H,Sadoshima S,Ooboshi H,Sato Y,Uchimura H,Fujishima M

    更新日期:1991-11-01 00:00:00