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Poor Prestroke Glycemic Control Increases the Rate of Symptomatic Intracranial Hemorrhage after Mechanical

Piotr Luchowski1, Maciej Szmygin2, Elzbieta Barton1

  • 1Department of Neurology and Neurological Nursing, Medical University of Lublin, 20-954 Lublin, Poland.

Journal of Clinical Medicine
|April 9, 2024
PubMed

Insights

Poor glycemic control in diabetic patients with acute ischemic stroke (AIS) did not affect 3-month outcomes after mechanical thrombectomy (MT). However, poorly controlled diabetes increased the risk of symptomatic intracranial hemorrhage following treatment.

Area of Science:

  • Neurology
  • Endovascular Therapy
  • Metabolic Disorders

Background:

  • Diabetes mellitus is a significant risk factor for acute ischemic stroke (AIS).
  • Prestroke glycemic control may influence outcomes in diabetic patients undergoing mechanical thrombectomy (MT).

Purpose of the Study:

  • To evaluate the impact of prestroke glycemic control on 3-month clinical outcomes in diabetic patients treated with MT for AIS.
  • To assess the relationship between glycemic control and stroke severity, reperfusion rates, symptomatic intracranial hemorrhage (sICH), and functional outcomes.

Main Methods:

  • Retrospective analysis of AIS patients (mRS 0-2) treated with MT within 6 hours of onset (Jan 2020 - Aug 2023).
  • Patients were categorized into non-diabetes (ND), well-controlled diabetes (WCD), and poorly controlled diabetes (PCD) groups.
  • Outcomes assessed included stroke severity (NIHSS), reperfusion, sICH, and modified Rankin Scale (mRS) at 3 months.

Main Results:

  • No significant differences in baseline NIHSS or time to groin puncture among ND, WCD, and PCD groups.
  • Favorable 3-month outcomes (mRS 0-2) and full recovery rates were similar across all groups.
  • Symptomatic intracranial hemorrhage (sICH) rates were significantly higher in the PCD group compared to ND and WCD groups (21.7% vs. 7.6% and 6.0%, respectively).
  • 3-month mortality did not differ significantly between the groups.

Conclusions:

  • Poor prestroke glycemic control in diabetic AIS patients does not adversely affect 3-month functional outcomes after MT.
  • Diabetic patients with poor glycemic control face an elevated risk of hemorrhagic complications post-MT.
  • Careful consideration of bleeding risk is warranted in diabetic patients with poor glycemic control undergoing endovascular treatment.

Keywords:
diabetesglycosylated hemoglobinischemic strokethrombectomy

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