This article is more than 5 years old. Information may no longer be current.
Hyperglycemia worsens outcomes after mechanical thrombectomy
Click Here to Manage Email Alerts
Patients with acute ischemic stroke treated with mechanical thrombectomy are at increased risk for poor outcomes when presenting with hyperglycemia, according to recent results.
The effects of elevated glucose levels may be more pronounced among patients who experience incomplete reperfusion after treatment, the researchers wrote.
In a post hoc analysis of the multicenter, randomized SWIFT trial, Joon-Tae Kim, MD, and colleagues evaluated glucose levels among 143 patients with acute ischemic stroke treated with mechanical thrombectomy within 8 hours of symptom onset.
Kim, of Chonnam National University Hospital in Gwangju, Korea, and colleagues stratified patients according to reperfusion completeness after treatment, as indicated by a score of 0 to 2 compared with 3 on the TIMI risk score. The primary outcome of interest was functional outcome at 3 months, with an excellent outcome identified as a modified Rankin scale score of 0 to 1. Other evaluated factors included a Rankin scale score of 0 to 2, complete reperfusion, intracranial hemorrhage and death.
Rankin scale scores at 3 months were available for 129 patients, 26.4% of whom had an excellent outcome and 25.2% of whom died during follow-up. Patients with excellent outcomes trended toward lower glucose levels than those without excellent outcomes (128 mg/dL vs. 145 mg/dL; P = .17); this difference did not achieve statistical significance after adjustment for covariates (OR = 0.87; 95% CI, 0.75-1 per 10 mg/dL glucose increase).
Mean glucose levels at presentation were similar between patients who did and did not achieve complete reperfusion (133 mg/dL vs. 144 mg/dL; P = .33), whereas patients with incomplete reperfusion trended toward lower glucose levels at presentation (113 mg/dL vs. 143 mg/dL for those without incomplete reperfusion; P = .09). Researchers observed an independent association between elevated glucose levels and poorer 3-month outcomes among patients with incomplete reperfusion (OR = 0.58; 95% CI, 0.34-0.99 for excellent outcome per 10 mg/dL glucose increase), but not those with complete reperfusion.
Excellent outcomes at 3 months were less common among patients who presented with hyperglycemia, defined as glucose levels of more than 140 mg/dL, compared with those who did not (13% of patients vs. 34%; P = .01). Rates of complete reperfusion were similar between patients with and without hyperglycemia at presentation (54% vs. 52%; P =.86). Results from multivariate analysis indicated an independent association between hyperglycemia at presentation and poor 3-month outcomes (OR = 0.22; 95% CI, 0.06-0.82).
“These results suggest that high glucose levels during [acute ischemic stroke] should be carefully managed in [mechanical thrombectomy] patients, most especially in those without complete reperfusion after the endovascular procedure,” the researchers wrote. “However, because of the variable clinical effects of hyperglycemia under different clinical circumstances, further investigation is warranted to confirm our results.” – by Adam Taliercio
Disclosure: One researcher reports receiving funding from and serving as a consultant for Medtronic Neurovascular. Another researcher reports receiving stock options from Cognition Medical and serving as a scientific consultant for Cognition Medical, Medtronic/Covidien, Neuravi and Stryker.
Click Here to Manage Email Alerts