Resident SUNY Upstate Syracuse, New York, United States
Introduction: Elevated peri-procedural glucose values may be associated with worse outcomes following mechanical thrombectomy (MT) for anterior circulation large vessel occlusion (ACLVO). We sought to evaluate the influence of peri-procedural glucose control on various outcomes following MT for ACLVO.
Methods: All patients who underwent MT for ACLVO between 2015 – 2021 at a single institution were reviewed. The independent variables included mean, minimum, maximum, and standard deviation of glucose values 24 hours and 1 week after MT. Outcomes included favorable functional status (modified Rankin Scale [mRS] 0 – 2) at 90 days and post-procedural intracranial hemorrhage (ICH). Multivariate logistic regression analyses adjusting for age, premorbid mRS, admission NIHSS, ASPECTS, collateral score, tPA administration, onset to reperfusion time, and TICI grade were performed.
Results: A total of 394 patients (199 males, 195 females) with a mean (SD) age of 71 years (15.2) were included. There were 106 (26.9%) patients with diabetes mellitus. Higher 24-hour maximum glucose was associated with lower odds of favorable 90-day mRS (OR 0.72, 95% CI 0.53 – 0.94) and greater odds of ICH (OR 1.34, 95% CI 1.07 – 1.69). Higher 24-hour glucose standard deviation was associated with greater odds of ICH (OR 1.38, 95% CI 1.10 – 1.77). There were 324 patients eligible for 1 week analysis. Greater 1 week glucose mean (OR 0.63, 95% CI 0.44 – 0.86), maximum (OR 0.55, 95% CI 0.38 – 0.76), and standard deviations (OR 0.55, 95% CI 0.38 – 0.76) were associated with lower odds of favorable 90-day mRS. None of the 1 week glucose parameters were associated with ICH.
Conclusion : Higher peak glucose and greater glucose variability 24 hours after MT are associated with worse functional outcomes and ICH. In the 1 week period after MT, higher peak glucose and greater glucose variability are associated with worse functional outcomes.
