Exploratory Analysis Supports Additional Investigation of Intravenous Glyburide for Hemispheric Ischemic Stroke

Ischemic strokes that involve most or all of the middle cerebral artery territory can cause malignant cerebral edema and mass effect, which in turn can lead to herniation, secondary injury, and death. Hyperosmolar therapy and decompressive hemicraniectomy are used to treat cerebral edema, but an ideal intervention would prevent cerebral edema.

Preclinical studies have suggested that a continuous intravenous infusion of glyburide, a long-available oral diabetes medication, can prevent cerebral edema and improve survival after large hemispheric stroke. These data led to the GAMES-RP study (Glyburide Advantage in Malignant Edema and Stroke), an industry-funded phase 2 randomized clinical trial that reported results in 2016. No significant safet…