Abstract WMP86: Risk Of Hemorrhagic Transformation Is Related To Severity Of Hba1c Elevation In Patients Undergoing Mechanical Thrombectomy

Abstract

Introduction: While prior studies have demonstrated hyperglycemia as an independent predictor of hemorrhagic transformation and poor clinical outcome following Mechanical Thrombectomy (MT), it is less clear to what extent HbA1c impacts these relationships. The objective of this study was to assess the association between severity of poor glycemic control, functional independence and hemorrhagic transformation. Methods: A retrospective analysis was performed on patients who underwent MT for large vessel occlusion (LVO) at a single comprehensive stroke center between January 2016 and January 2022. Primary safety and efficacy outcomes included the presence of hemorrhagic transformation and good 90-day functional outcome defined as modified Rankin scale (mRS) of 0-2. Good glycemic control was described as HbA1c <6.4 mg/dl. Fisher’s Exact Probability Test was used to compare cohorts to those with good glycemic control and calculate odds ratios for given outcomes. Results: 657 patients were included in the analysis. Among these, the observed HbA1c value was <6.5 (n=535), 6.5-8.0 (n=72), or >8.0 (n=50). There were no significant differences between cohorts in terms of age, gender, ethnicity, initial NIH stroke scale, level of occlusion, or medical comorbidities. Patients with HbA1c ≥6.5 had a 17.0% lower incidence of good functional outcome vs those with good glycemic control (OR 0.47, CI: 0.32-0.88). An HbA1c threshold of ≥6.5 did not correlate with significant differences in HT incidence (OR 1.08, CI: 0.76-1.79). However, patients with HbA1c > 8.0 had a 14.8% higher incidence of HT vs those with good glycemic control (OR 1.81, CI: 1.15-4.35). Conclusions: While suboptimal glucose control and diabetes (HbA1c ≥6.5) is associated with worse outcomes following MT for acute ischemic stroke, its effect on hemorrhagic transformation risk was only seen in those with poor glycemic control (HbA1c >8.0) in our single center analysis.