Association of Blood Glucose and Clinical Outcome after Mechanical Thrombectomy for Acute Ischemic Stroke

Abstract

Background: Elevated blood glucose levels following acute ischemic stroke have been associated with adverse clinical outcomes in thrombolytic and nonthrombolytic treated patients. The current study examined multiple blood glucose parameters and their association with modified Rankin Scale (mRS) score at 3 months following mechanical thrombectomy and hospital discharge. Methods: Acute ischemic stroke patients undergoing mechanical thrombectomy with a retrievable stent at two stroke centers were studied. Admission blood glucose level, maximum blood glucose during the hospital stay, and serial blood glucose measurements within the first 24 h of hospital admission were recorded. Variability in blood glucose level was represented by the standard deviation of the serial measurements within the first 24 h. The following demographic and clinical data was also collected: age, sex, baseline NIHSS score, onset-to-reperfusion times, hemoglobin A1c, and stroke mechanism. Results: 79 patients were identified; at 3 months, 35 patients had an mRS score of 0–2 and 44 had had an mRS of 3–6. Among the blood glucose variables, standard deviation of blood glucose in the first 24 h following admission and maximum blood glucose during hospital stay were significantly higher in the mRS 3–6 group. In multivariate logistic regression analysis, only the standard deviation of blood glucose remained significant (OR = 1.07, 95% CI = 1.02–1.11, p = 0.003) in a model that adjusted for admission NIHSS score (p = 0.016) and number of stent retriever passes (p = 0.042). Conclusions: Greater blood glucose variability following acute ischemic stroke is associated with worse clinical outcome in patients undergoing mechanical thrombectomy.

Admission Glucose Levels May Increase the Risk for Early Neurological Deterioration in Females With Acute Ischemic Stroke

“…It is known that patients with hyperglycemia have increased risk for stroke especially ischemic stroke (11). Elevated levels of blood glucose in the periinfarct period are closely associated with poor outcome in patients with AIS (12). Clinical studies suggested that there might be a sex difference in the response to treatments and clinical outcomes for patients with AIS.…”

Impact of blood pressure levels within first 24 hours after mechanical thrombectomy on clinical outcome in acute ischemic stroke patients

“…Different factors may have an impact on functional outcome after MT, [2][3][4] nevertheless, some cannot be affected and some have not yet been sufficiently established.…”

Intensive Care Management Following Endovascular Clot Retrieval for Acute Stroke: A Systematic Review of the Literature

“…4 As such, 16 clinical studies were included in this review. [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] The flow of studies and reasons for exclusion are shown in ►Fig. 1.…”

“…Gordon et al and Natarajan et al both report retrospective cohort studies that suggest a correlation between hyperglycaemia in early acute stroke treated with ECR and poor functional outcome. 6,19 In line with the recommendations of AIS more broadly, most guidelines recommend treatment of hyperglycaemia in excess of 10 mmol/L (180 mg/dL). 24,38,39…”