Abstract
Introduction: Diabetes mellitus has deleterious effects on blood vessel integrity via several mechanisms including blood brain barrier injury, excitatory chemokines, acidosis, and edema. It has been associated with symptomatic intracerebral hemorrhage (sICH) after alteplase administration for ischemic stroke. We aim to determine the association between diabetes and sICH in patients undergoing thrombectomy. Methods: Data was abstracted from the Rhode Island Hospital prospective stroke registry and included consecutive patients who were selected for thrombectomy at our institution over a period of 24 months with the goal of identifying risk factors for sICH. The primary predictor was history of diabetes and the primary outcome was sICH defined based on the modified SITS-MOST criteria (parenchymal hematoma along with increase in NIHSS by 4 points or more). We compared baseline characteristics between patients with and without sICH using univariate and multivariable analyses. Statistical analysis was performed using SPSS version 20.0 and a p value of <0.05 was statistically significant. Results: Out of 307 patients, 12 (3.9%) experienced sICH. The mean age was 73 years; 49.2% were men. On univariate analyses, diabetes mellitus was associated with sICH (50.0% vs. 17.3%, p= 0.012). This association persisted on multivariable models adjusting for age, NIHSS score, ASPECTS score, time to reperfusion, and TICI score (Odds Ratio 6.0, 95% CI 1.5-23.3, p=0.011). We performed sensitivity analyses excluding patients who received intravenous tPA (n = 189) and the results remained unchanged (OR 8.5, 95% CI 0.84-83.3, p = 0.071). Conclusion: Diabetes mellitus is an independent predictors of sICH in patients with acute ischemic stroke undergoing mechanical thrombectomy, with or without IV tPA. More studies are needed to confirm our findings and to determine blood sugar control in the post-thrombectomy reduces this risk.
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