564 The Influence of Presenting Glucose and Glycated Hemoglobin on Outcomes Following Mechanical Thrombectomy for Anterior Circulation Large Vessel Occlusion

Abstract

INTRODUCTION: Elevated presenting glucose and glycated hemoglobin (HbA1C) values may be associated with worse outcomes following mechanical thrombectomy (MT) for anterior circulation large vessel occlusion (ACLVO). METHODS: All patients who underwent MT for ACLVO between 2015 – 2021 at a single institution were reviewed. The outcomes included favorable functional status (modified Rankin Scale [mRS] 0 – 2) at 90 days, any intracranial hemorrhage (ICH), parenchymal hemorrhage, and malignant middle cerebral artery infarction (MMI). Multivariate logistic regression analyses adjusting for age, premorbid mRS, admission NIHSS, ASPECTS, collateral score, tPA administration, onset to reperfusion time, and TICI grade were performed. Youden’s index was used to identify thresholds for glucose and HbA1C that optimized area under the receiving operator characteristic curve for predicting outcomes. RESULTS: A total of 332 patients were included. The mean (SD) age was 70.9 years (15.1), 50.3% of patients were female, and 26.9% of patients had a history of diabetes. The median (IQR) presenting glucose, SGR, and HbA1C values were 118 mg/dL (40), 1.0 (0.35), and 5.7% (1.0), respectively. Presenting glucose was associated with any ICH (OR 1.38, 95% 1.08 – 1.80) and MMI (OR 1.48, 95% CI 1.06 – 2.03), but not functional status. SGR was not associated with any outcome. Presenting HbA1C was associated with MMI (OR 1.43, 95% 1.02 – 2.02) but not functional status or ICH. The optimal threshold among glucose values for predicting ICH and MMI were 167 mg/dL and 128 mg/dL, respectively. For HbA1c, the threshold for predicting MMI was 6.0. CONCLUSIONS: Presenting glucose and HbA1C were associated with MMI, and glucose was associated with ICH after MT for ACLVO. Improved glucose control prior to admission could decrease the odds of these events.