24H FOLLOW-UP CT| METFORMIN PRETREATMENT: TWO REFLECTIONS FROM CLINICAL STROKE PRACTICE

Abstract

Acute ischemic stroke is a serious medical emergency caused by the blockage of blood flow to the brain. With an estimated 15 million new cases each year, it is a leading cause of morbidity and mortality worldwide. The evaluation of the clinical stroke treatment and care is, therefore, crucial to mitigate the burden of this severe disease. In this thesis, we conducted two observational studies which made two reflections on clinical stroke care by analyzing the Comprehensive stroke center database at Massachusetts General Hospital (MGH) from 2012-2022, which contained 8943 patients with acute stroke admitted to MGH.

Over the past few decades, thrombolytic and endovascular therapies have become became the mainstay of acute ischemic stroke treatment. However, the routine imaging of 24h non-contrast head computed tomography (CT) for patients post thrombolysis and thrombectomy can be costly and time-consuming. In the first paper, we aimed to evaluate the utility of 24-hour per-protocol CT scan for patients who have undergone thrombolysis or mechanical thrombectomy. We aimed to identify the risk factors for clinically meaningful CT scans and predict changes in management. This could help reduce unnecessary imaging and optimize patient care.

Metformin is a widely used oral antidiabetic medication that has been shown to have neuroprotective effects in animal models of stroke. Previous studies have also shown that patients with stroke and diabetes on treatment with metformin post intravenous thrombolysis had less severe strokes on admission. In the second paper, we hypothesized that pretreatment with metformin for patients with type 2 diabetes had less severe strokes on admission, less mortality during hospitalization, and better functional outcomes at discharge. This research could lead to a better understanding of the neuroprotective effects of metformin and inform stroke treatment strategies for patients with diabetes.

By analyzing the Comprehensive Stroke Center database and investigating the use of 24-hour per-protocol CT scans and the effects of metformin treatment, this thesis aims to improve our understanding of acute ischemic stroke treatment and care.