Relevance of admission hyperglycaemia and diabetes mellitus to efficacy and safety of mechanical thrombectomy in stroke patients

Abstract

Introduction. The relevance of diabetes mellitus (DM) to the efficacy of mechanical thrombectomy (MT) has been the subject of few studies and with only inconclusive results.Objectives. This study aimed to evaluate the effect of DM and admission hyperglycaemia on the efficacy and safety of MT in stroke patients. Material and methods.This retrospective study analysis focused on the relevance of admission hyperglyacemia and DM to the functional status of patients treated with MT at the Upper Silesian Medical Centre of the Silesian Medical University in Katowice, Poland.Results. 417 stroke patients (median age 70 years) were qualified for the study. There were 103 patients (24.70%) with DM. Admission hyperglycaemia ≥ 140 mg% was found in 91 patients (21.82%), of whom 69 were diagnosed with DM before or during hospitalisation. The parameters with the strongest effect on the functional status on days 7, 90 and 365 were: age, and neurological status according to the National Institutes of Health Stroke Scale (NIHSS) on the first day of ischaemic stroke before MT. The angiographic effect indirect after MT and patient functional status on days 7, 90 and 365 were comparable between the groups, regardless of the DM burden. The frequency of symptomatic intracranial bleeding 24 hours after MT was comparable between patients with and patients without DM (p = 0.092).Model based on parameters were age, NIHSS on the first day of ischaemic stroke, an when score in Thrombolysis In Cerebral Infarct (TICI) showed good predictive attributes for the functional status of patients in the acute period (day 7). Age, a lack of admission hyperglycaemia, and the neurological state on day 1 of ischaemic stroke (before MT) were the key parameters for a favourable outcome (≤ 2 points on the modified Rankin Scale, mRS) on day 90. Admission hyperglycaemia ≥ 140 mg/dL, regardless of the presence or absence of DM, had a negative effect on achieving a good functional status one week after stroke onset. Conclusions. Diabetes mellitus has a neutral effect on the angiographic and clinical outcomes of mechanical thrombectomy in stroke patients. It does not increase the risk of intracranial haemorrhage after instrumental therapy. It is admission hyperglycaemia, rather than diabetes mellitus, that is a predictor of poor functional status in patients treated with thrombectomy. According to our results, the patient's neurological status, age, and the outcome of thrombectomy are relevant to the functional status in the acute ischaemic stroke period.

Associations between basic physiological observations recorded pre-thrombectomy and functional outcome: a systematic review and meta-analysis

“…Figure 3 demonstrates that hyperglycaemia >/ = 7.8mmool/L had a significant association with unfavourable functional outcome: OR = 2.44 (95%CI 1.9 to 3.14, Z = 6.96), p < 0.00001. This was consistent for all six studies (Bouslama et al, 2018;Goyal et al, 2018;Huo et al, 2019;Rinkel et al, 2020;Genceviciute et al, 2022;Lasek-Bal et al, 2022) (Supplementary Table S6). The highest weighted studies (Bouslama et al, 2018;Rinkel et al, 2020;Genceviciute et al, 2022) showed a clear association and lower weighted studies had greater mean differences (Huo et al, 2019;Lasek-Bal et al, 2022).…”

“…This was consistent for all six studies (Bouslama et al, 2018;Goyal et al, 2018;Huo et al, 2019;Rinkel et al, 2020;Genceviciute et al, 2022;Lasek-Bal et al, 2022) (Supplementary Table S6). The highest weighted studies (Bouslama et al, 2018;Rinkel et al, 2020;Genceviciute et al, 2022) showed a clear association and lower weighted studies had greater mean differences (Huo et al, 2019;Lasek-Bal et al, 2022). Risk of bias was low (mean 12.08/14).…”

Predictors of good functional outcome in ischaemic stroke patients without delayed neurological improvement after mechanical thrombectomy

“…Moreover, considering the severity of cerebral oedema and the generally poor conditions of such patients, we suspect that they would be less likely to achieve DNI. Also, we did not specifically classify patients into a hyperglycaemia group, which again could contribute to patient outcomes [34]. Rather than doing that, we treated serum glucose level as a continuous variable, as this approach is generally thought to be more statistically robust.…”

Association between within-visit blood pressure variability, stroke, coronary heart disease, and cardiovascular mortality

“…It should be noted that a previous study (conducted in Poland) revealed a higher prevalence of arterial hypertension and peripheral arterial disease in the lower limbs among patients with DM [22]. This could lead to a compromised www.journals.viamedica.pl/neurologia_neurochirurgia_polska Bhrugun Anisetti et al, Association between within-visit BP variability, stroke, CHD and CV mortality bloodflow and vascular function in peripheral arteries that may lead to fluctuations in blood pressure readings.…”

“…Additionally, the inflammatory response triggered by stress might elevate the levels of circulating free fatty acids in individuals with acute illnesses, which can negatively affect the ability of the endothelium to dilate blood vessels. Moreover, hyperglycaemia can contribute to reperfusion injury by intensifying oxidative stress and inflammation [22].…”