Five-Day Glycemic Patterns and 3-Month Functional Outcomes After Endovascular Thrombectomy

Admission hyperglycemia is associated with poor outcomes after endovascular thrombectomy (EVT) for acute ischemic stroke, but whether post-EVT glycemic pattern determines functional outcome remains unknown.

A Retrospective Study for the Prediction of Clinical Outcomes in Acute Ischemic Stroke Patients with Thrombectomy study was a hybrid prospective-retrospective multicenter cohort study nested within the Rescue on Reperfusion Damage in Cerebral Infarction by Nelonemdaz trial (NCT05041010) across 24 tertiary stroke centers in South Korea. Patients with ≥80% measurements within 80-140 mg/dL and no value ≥200 mg/dL were classified as normoglycemic (Group 1); the remainder were classified by group-based trajectory modeling into persistently elevated (Group 2) and variable hyperglycemia (Group 3). The primary outcome was 3-month modified Rankin Scale (mRS) distribution.

Among 457 patients, 319 were included (mean age 73.6±12.2 years; 53.6% male): 97 (30.4%) in Group 1, 159 (49.8%) in Group 2, and 63 (19.7%) in Group 3. Groups 2 and 3 had more diabetes and higher hemoglobin A1c; stroke severity, Alberta Stroke Program Early Computed Tomography Scores, and reperfusion status were comparable. Both hyperglycemic groups had lower odds of a favorable mRS shift than Group 1 (adjusted common odds ratio [OR] 0.35, 95% confidence interval [CI] 0.20-0.61 and 0.49, 0.25-0.94). Functional independence (mRS 0-2) was achieved in 63.9% of Group 1 versus 36.5% and 38.1% in Groups 2 and 3 (adjusted OR 0.26, 95% CI 0.13-0.53 and 0.31, 0.13-0.73). No significant difference was observed between Groups 2 and 3.

Five-day post-EVT hyperglycemic status was independently associated with worse 3-month functional outcomes beyond chronic glycemic burden, supporting re-evaluation of targeted glycemic interventions during this vulnerable window.