Background: Hyperglycemia on admission is known to be associated with poor outcome after intravenous or intra-arterial thrombolysis treatment in patient with acute ischemic stroke. However, its effect on mechanical thrombectomy outcomes remains elusive. We investigated whether clinical and procedural outcomes differ between normoglycemic and hyperglycemic patients with large vessel occlusion stroke after endovascular therapy.
Methods: We reviewed our prospectively collected endovascular database at a tertiary care academic institution between 9/2010-12/2016. Hyperglycemia was defined as admission serum glucose >140mg/dl. All patients that underwent ET for anterior circulation large vessel occlusion acute ischemic stroke were included and categorized into two groups according to their glycemic status. Baseline and procedural characteristics, as well as outcome parameters were compared.
Results: A total of 931 patients qualified for the study of which 289 (31%) had hyperglycemia on admission. Those with hyperglycemia were older (p=0.001), had more comorbidities and more severe strokes as assessed by the NIHSS (19[15-23] vs 17[13-21], p=0.01). In univariate analysis, Hyperglycemic patients had lower rates of successful reperfusion (mTICI2b-3, 85.4% vs 90.6%,, p=0.02) and 90-day good outcomes (mRS 0-2, 32.7% vs 52.3%, p<0.01) and higher rates of parenchymal hematomas (11.5% vs 7.5%, p=0.04) and 90-day mortality (35% vs 16.6%, p<0.01). After adjustment for confounders, Hyperglycemia remained associated with decreased successful reperfusion (OR 0.55 95%CI [0.31-0.96], p=0.03) and good outcome (OR 0.52 95%CI [0.34-0.79], p=0.002) and increased mortality (OR 2.39 95% CI [1.45-3.82], p<0.001). However, it was no longer a predictor of parenchymal hematomas.
Conclusions: Our study confirms that hyperglycemia is associated with poorer procedural and clinical outcomes in patients undergoing mechanical thrombectomy for large vessel occlusion strokes.