Higher baseline blood glucose is associated with reduced likelihood for successful recanalization in patients with basilar artery occlusion

Abstract

Purpose Evidence regarding the effect of mechanical thrombectomy (MT) of basilar artery occlusion (BAO) stroke is yet sparse. As successful recanalization has been suggested as major determinant of outcome, the early identification of modifiable factors associated with successful recanalization could be of importance to improve functional outcome. Hyperglycemia has been associated with enhanced thrombin generation and unfavorably altered clot features. Objective We hypothesized that serum baseline glucose is associated with likelihood of vessel recanalization mediated by collateral quality and clot burden in BAO stroke. Methods BAO stroke patients who received multimodal CT on admission were analyzed. The association of vessel recanalization defined using modified Thrombolysis in cerebral infarction scale (mTICI) scores 2b-3, and baseline imaging and clinical parameters were tested in logistic regression analyses. Collateral quality and clot burden were evaluated using the Basilar Artery on CT-Angiography (BATMAN) score. Results Out of 117 BAO patients, 91 patients (78%) underwent MT. In 70 patients (77%), successful recanalization could be achieved (mTICI 2b/3). In multivariable logistic regression analysis, only a higher BGL (aOR 0.97, 95% CI 0.96–0.99, p = 0.03) and higher BATMAN score (aOR 1.77, 95% CI 1.11–2.82, p = 0.02) were independently associated with vessel recanalization. Application of alteplase, or time from symptom onset-imaging revealed no independent association with recanalization status. Conclusion Higher BGL was significantly associated with reduced likelihood for recanalization success besides BATMAN score as a measure of collateral quality and clot burden. BGL could be tested as a modifiable parameter to increase likelihood for recanalization in BAO stroke, aiming to improve functional outcome.

Patterns of Care in Patients with Basilar Artery Occlusion (BAO): A Population-Based Study

“…Moreover, we also observed a higher proportion of patients with atrial fibrillation (AF) (31.5%) and a lower proportion with diabetes mellitus (39.5%) in the EVT group as compared with the non-EVT group. These observations are reflective of the general practice and are in line with the previous findings, which reported that higher blood glucose levels are associated with decreased rates of recanalization, functional outcome, and mortality [ 21 , 22 , 23 , 24 ]. Consistent with our findings, other studies have also reported a higher proportion of patients with AF undergoing EVT, probably because cardiac emboli frequently cause BAO [ 3 ].…”

Effects of admission hyperglycemia and intravenous thrombolysis allocation in acute basilar artery occlusion after endovascular treatment: Analysis of the ATTENTION registry

“…In accordance with prior studies [ 10 , 21 , 27 ], hyperglycemia on admission was not related to successful recanalization in our cohort. In contrast, a different study including 117 BAO patients (91 of which treated with MT) [ 14 ] demonstrated that lower baseline serum glucose levels were associated with successful vessel recanalization. In this study, Broocks et al.…”

“…Admission hyperglycemia was correlated with functional outcomes in patients with OTA >4.5 ​h but not in those with OTA ≤4.5 ​h. Late window patients may be most affected by glucose due to its effects on infarct growth and collaterals [ 9 , 14 ]. Further studies may illuminate the underlying causes.…”

“…A recent meta-analysis performed on AIS patients who had mechanical thrombectomy (MT) showed that higher glucose levels on admission were associated with worse long-term outcome [ 13 ]. One study [ 14 ] suggested that baseline serum glucose levels can be used as a modifiable parameter to increase the likelihood of improving functional outcome in BAO. Yet the findings of this study were limited by their sample size, and further analyses on larger cohorts of patients are needed.…”