Impact of Glucose on Outcomes in Patients Treated With Mechanical Thrombectomy

Abstract

6-8 perhaps because, among patients treated with intravenous thrombolysis, reperfusion occurs in only 40% to 50% and documentation of reperfusion timing and extent imprecise.Accordingly, the advent of mechanical thrombectomy (MT), which more frequently achieves reperfusion and permits more exact characterization of reperfusion timing and extent, offers an opportunity to more clearly evaluate the potential Background and Purpose-Sparse data are available regarding the association between hyperglycemia and outcomes in acute ischemic stroke patients receiving mechanical thrombectomy (MT). We investigated whether hyperglycemia affected the outcomes of subjects treated with MT in the Solitaire Flow Restoration With the Intention for Thrombectomy (SWIFT) multicenter randomized trial, overall and according to reperfusion status after MT. Methods-We analyzed the relationships between the presenting glucose level as a continuous variable and presenting hyperglycemia (>140 mg/dL glucose) as a binary variable and several outcomes of interest. Subjects were stratified according to the completeness of reperfusion (Thrombolysis In Myocardial Ischemia scale 3 versus 0-2) after MT. Excellent outcome at 3 months was defined as a modified Rankin scale score of 0-1. Results-Among all patients undergoing MT, patients with hyperglycemia less frequently exhibited an excellent outcome at 3 months than patients without hyperglycemia, 13% versus 34%; P=0.01. Presenting glucose levels did not differ among patients achieving complete reperfusion and incomplete reperfusion. Among patients with incomplete reperfusion, after adjustment for covariates, higher glucose levels were independently associated with worse outcome at 3 months (per 10 mg/dL increase in glucose: odds ratio for modified Rankin scale score 0-1 at 3 months 0.58, 95% confidence interval 0.34-0.99; P=0.047). In contrast, among patients with complete reperfusion, differences in presenting glucose levels by final outcome did not reach statistical significance. Conclusions-In patients treated with MT, hyperglycemia was independently associated with worse outcome at 3 months, and the negative effects of hyperglycemia may have been exacerbated in patients with incomplete reperfusion after MT. Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT01054560.

Clinical Effectiveness and Safety Outcomes of Endovascular Treatment for Acute Anterior Circulation Ischemic Stroke in China

“…In accordance with previous studies, our study also found that old age [27], severe neurological deficits [27], high baseline glucose level [28], pneumonia [29,] and sICH [30] were independent predictors for poor functional outcome. Moreover, small baseline infarct core (ASPECTS 8-10) [31], successful revascularization (mTICI 2b-3) [27,32], good collateral status (2-3) [33,34], and OTT ≤6 h [27,35,36] were protective factors.…”

Glycated hemoglobin (HbA1c) and outcome following endovascular thrombectomy for ischemic stroke

“…In this study there were no significant associations between admission glucose levels and patient outcome. This is in contrast to previous reports where admission hyperglycemia was associated with worse outcome in both alteplase and endovascular thrombectomy patients 1–3. Mechanisms of acute hyperglycemia-related damage include early platelet and leucocyte adhesion and accumulation in cortical microvessels, along with leucocyte extravasation, blood–brain barrier disruption, and postcapillary microthrombosis 19 24.…”

“…Admission hyperglycemia is associated with worse outcome in patients with ischemic stroke treated with intravenous alteplase and endovascular thrombectomy 1–3. In these patients, admission hyperglycemia may indicate either ‘stress’ hyperglycemia or pre-existing impaired glucose metabolism 4.…”

Multisociety Consensus Quality Improvement Revised Consensus Statement for Endovascular Therapy of Acute Ischemic Stroke

“…These cases should not be considered in isolation, as a poor outcome does not necessarily indicate that such physicians are providing a lower quality of care, but rather that they have a different patient mix than the trials that were used to create the benchmarks. 7,8,10,11,[13][14][15]18,20,[143][144][145] Adjusting for risk and severity may be helpful in assessing local outcomes compared with other institutions and benchmarks. Endovascular QI case review triggers and key process metrics are summarized in Table 3.…”