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Review
. 2011 Mar;31(3):807-18.
doi: 10.1038/jcbfm.2010.210. Epub 2010 Dec 15.

Hyperglycaemia and infarct size in animal models of middle cerebral artery occlusion: systematic review and meta-analysis

Niall J J MacDougall  1 , Keith W Muir
Affiliations
Review

Hyperglycaemia and infarct size in animal models of middle cerebral artery occlusion: systematic review and meta-analysis

Niall J J MacDougall et al. J Cereb Blood Flow Metab. 2011 Mar.

Abstract

Poststroke hyperglycaemia (PSH) is common, has an unclear pathophysiology, and is associated with poor outcomes. Animal studies report conflicting findings. We systematically reviewed the effects of hyperglycaemia on infarct volume in middle cerebral artery occlusion (MCAO) models, generating weighted mean differences between groups using random effects models summarised as effect size (normalised to control group infarct volume as 100%) and 95% confidence interval. Of 72 relevant papers, 23 reported infarct volume. Studies involved 664 animals and 35 distinct comparisons. Hyperglycaemia was induced by either streptozotocin (STZ, 17 comparisons, n=303) or dextrose (18 comparisons, n=356). Hyperglycaemic animals had infarcts that were 94% larger, but STZ was associated with significantly greater increase in infarct volumes than dextrose infusion (140% larger versus 48% larger). In seven studies, insulin did not significantly reduce infarct size and results were heterogeneous. Although hyperglycaemia exacerbates infarct volume in MCAO models, studies are heterogeneous, and do not address the common clinical problem of PSH because they have used either the STZ model of type I diabetes or extremely high glucose loads. Insulin had a nonsignificant and significantly heterogeneous effect. Further studies with relevant models may inform clinical trial design.

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Figures

Figure 1
Figure 1
Flow chart of systematic review process.
Figure 2
Figure 2
Bias assessment plot for effect of hyperglycaemia on infarct size. Graph A is a bias assessment plot for all hyperglycaemic studies. Graph B is a bias assessment plot for studies using streptozotocin. Graph C is a bias assessment plot for studies using dextrose.
Figure 3
Figure 3
Meta-analysis of effect of hyperglycaemia on infarct size. d.f., degrees of freedom; 95% CI, 95% confidence interval.
Figure 4
Figure 4
Meta-analysis of effect of insulin on infarct growth. d.f., degrees of freedom; pMCAO, permanent middle cerebral artery occlusion; rMCAO, reversible middle cerebral artery occlusion; 95% CI, 95% confidence interval.
See this image and copyright information in PMC

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References

    1. Adams HP, Jr, del Zoppo G, Alberts MJ, Bhatt DL, Brass L, Furlan A, Grubb RL, Higashida RT, Jauch EC, Kidwell C, Lyden PD, Morgenstern LB, Qureshi AI, Rosenwasser RH, Scott PA, Wijdicks EF. Guidelines for the Early Management of Adults with Ischemic Stroke: a guideline from the American Heart Association/American Stroke Association Stroke Council, Clinical Cardiology Council, Cardiovascular Radiology and Intervention Council, and the Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Research Interdisciplinary Working Groups: the American Academy of Neurology affirms the value of this guideline as an educational tool for neurologists. Stroke. 2007;38:1655–1711. - PubMed
    1. Araki N, Greenberg JH, Sladky JT, Uematsu D, Karp A, Reivich M. The effect of hyperglycemia on intracellular calcium in stroke. J Cereb Blood Flow Metab. 1992;12:469–476. - PubMed
    1. Baird TA, Parsons MW, Phanh T, Butcher KS, Desmond PM, Tress BM, Colman PG, Chambers BR, Davis SM. Persistent poststroke hyperglycemia is independently associated with infarct expansion and worse clinical outcome. Stroke. 2003;34:2208–2214. - PubMed
    1. Banwell V, Sena ES, Macleod MR. Systematic review and stratified meta-analysis of the efficacy of interleukin-1 receptor antagonist in animal models of stroke. J Stroke Cerebrovasc Dis. 2009;18:269–276. - PubMed
    1. Berger L, Hakim AM. Nimodipine prevents hyperglycemia-induced cerebral acidosis in middle cerebral artery occluded rats. J Cereb Blood Flow Metab. 1989;9:58–64. - PubMed

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