Abstract WMP92: Presentation Blood Glucose Is Associated With CTP Core Volume Overestimations In Acute Ischemic Stroke Patients With Large Vessel Occlusion

Abstract

Background: CT Perfusion (CTP) predictions of infarct core play a large role in determination of treatment eligibility in large vessel occlusion (LVO) acute ischemic stroke (AIS). Prior studies have demonstrated that glucose can affect cerebral blood flow (CBF). Here we evaluate the influence of acute and chronic glucose levels on CTP over-estimation (OE) of infract core, leading to potential undertreatment. Methods: From our prospectively collected multicenter observational cohort, we identified AIS LVO patients evaluated with non-contrast CT, CTA and concurrent CTP who underwent endovascular therapy with substantial reperfusion (TICI2b-3), and also had MRI 48-72 hours post-treatment. OE was defined as a difference of at least 20 mL between CTP-RAPID (IschemaView, Stanford CA) predicted infarct core and DWI final infarct volume (FIV). The primary outcome was the association of glucose and HgbA1c on OE and was measured using multivariable logistic regression to control for other patient level factors. Results: Among 256 patients meeting inclusion criteria, median age was 67 [IQR 57-77] and 51.6% were female. Median CTP-predicted core was 6 mL [IQR 0-30], median DWI FIV was 14 mL [IQR 6-43] with median difference of 12 mL [IQR 5-35]. 28 patients (10.9%) had OE, with median difference in infarct size of 40 mL [24-56]. In univariable analysis, early time window (<6 hours from last known well), absence of diabetes, normal HgbA1c, and normal admission glucose were associated with OE. In multivariate analysis, early time window (aOR 2.87, p=0.025) and lower/normal glucose (aOR 3.01, p=0.02) were independent predictors of OE. Among 65 patients with higher HgbA1c and blood glucose levels (>6.5, >126), 27 patients (42%) had CTP core under-estimation (UE). Conclusions: Acute and chronic changes in glycemic state affect automated CTP interpretations. These findings may be related to previously described effects on cerebral blood flow.