Glucose Levels May Affect Functional Outcomes After Endovascular Thrombectomy

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The median pretreatment collateral score was 2, and 35% of patients had good collaterals.
The median pretreatment collateral score was 2, and 35% of patients had good collaterals.

Hyperglycemia may affect functional outcome after endovascular thrombectomy, depending on collateral status at the time of acute ischemic stroke, according to data presented at the American Academy of Neurology 2017 Annual Meeting in Boston, Massachusetts, April 22 to 28.

A multi-international team of researchers hypothesized that the effect of hyperglycemia on functional outcome and reperfusion may differ according to collateral status. The researchers collected patient data from 3 stent retriever trials and registries. A total of 309 patients (mean age, 67 years; mean presenting glucose, 131±55 mg/dL) had available angiographic data on collaterals.

Angiograms were scored for collateral grades using the American Society of Intervention and Therapeutic Neuroradiology (ASITN) scale. The median pretreatment collateral score was 2, and 35% of patients had good collaterals (grade 3-4).

More than 77% of patients had substantial reperfusion, and more than 50% had good outcomes at 90 days (modified Rankin scale, 0-2). Although glucose levels were not associated with collateral status or reperfusion, lower levels were observed in patients with good final outcomes (124 vs 140 mg/dL; P =.01).

Ultimately, collateral status altered the effect of glucose on outcomes. For example, in patients with poor collaterals, higher glucose did not alter outcomes (per 10 mg/dL increase: odds ratio [OR], 0.98; 95% CI, 0.92-1.04; P =.46), but in patients with good collaterals, high glucose levels reduced the probability of good outcomes (per 10 mg/dL increase: OR, 0.81; 95% CI, 0.69-0.95; P =.012).

"Higher glucose levels reduce likelihood of good outcome among patients with good collaterals, but do not affect outcome among patients with poor collaterals," the researchers concluded.

Reference

Kim J-T, Liebeskind D, Jahan R, Menon B, Nogueira R, Saver J. Impact of hypoglycemia according to collateral status on reperfusion and outcomes in acute ischemic stroke after mechanical thrombectomy. Presented at: American Academy of Neurology 2017 Annual Meeting April 22-28, 2017; Boston, MA. 

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