Heterogeneity affecting outcome from acute stroke therapy - Making reperfusion worse

Background-Stroke patients are heterogeneous not only with respect to etiol ogy but also in terms of preexisting clinical conditions. Approximately one fifth of patients with acute stroke are hyperglycemic and/or have had a re cent infectious or inflammatory condition. Summary of Review-Experimental research indicates that these factors can al ter and accelerate the evolution of stroke and reperfusion injury, although these effects are complex and some may have a favorable impact. Both condi tions involve activation of inflammatory and reactive oxygen mechanisms. In addition, hyperglycemia has concomitant deleterious vascular and metabolic effects that worsen infarct size and encourage hemorrhagic transformation in reperfusion models. Clinical data are less extensive but in general supp ort an adverse impact on outcome. Conclusions-After examining these data in detail, we concluded that the pre sence of these clinical conditions could assist in identification of those at increased risk for complications of reperfusion therapy. Furthermore, co nsideration of these factors may provide a rational basis for combination t herapy and improve the clinical relevance of experimental stroke models.