Association of Post-procedural Glucose with Clinical Outcomes After Endovascular Therapy for Large Vessel Occlusion

Glucose at admission predicted poor outcome for patients with acute large vessel occlusion (LVO) undergoing endovascular therapy (EVT). Prior studies ignored continuous glucose monitoring after EVT. Therefore, we aim to evaluate the association between post-procedural glucose levels and outcomes in real-world settings.

This study was based on a multicenter cohort. Patients with LVO who underwent EVT within 24 h of symptom onset were enrolled. We analyzed post-procedural blood glucose based on preprandial blood glucose levels within 48 h after EVT recognizing disrupted normal dietary patterns and circadian rhythms due to severe symptoms of LVO. Primary clinical outcome was functional independence (90-day modified Rankin scale score 0-2). We evaluated the association between post-procedural glucose and functional independence using logistic regression and assessed whether stroke severity modified this association.

A total of 693 patients were included. Multivariate logistic regression analysis showed that decreased average post-procedural glucose per unit was significantly related to functional independence (adjusted odds ratio [aOR]: 0.75, 95% confidence interval [CI] 0.68-0.83, P < 0.001). Hyperglycemia was defined as any preprandial blood glucose within 48 h after EVT ≥ 7.6 mmol/L based on the restricted cubic spline regression model. The hyperglycemia group was also significantly associated with functional independence (aOR: 0.54, 95% CI 0.36-0.82, P = 0.003), symptomatic intracranial hemorrhage (aOR: 2.16, 95% CI 1.08-4.34, P < 0.001), and 90-day mortality (aOR: 1.71, 95% CI 1.04-2.79, P = 0.033). Subgroup analysis specifically in individuals with severe stroke (defined as National Institutes of Health Stroke Scale [NIHSS] ≥ 15) showed that hyperglycemia was a risk factor for low functional independence.

Increased post-procedural glucose is associated with poor functional outcome after endovascular treatment and an increased risk of symptomatic intracranial hemorrhage after endovascular treatment, especially for those with more severe strokes.