Impact of Glucose on Outcomes in Patients Treated With Mechanical Thrombectomy: A Post Hoc Analysis of the Solitaire Flow Restoration With the Intention for Thrombectomy Study

Abstract

Background and purpose: Sparse data are available regarding the association between hyperglycemia and outcomes in acute ischemic stroke patients receiving mechanical thrombectomy (MT). We investigated whether hyperglycemia affected the outcomes of subjects treated with MT in the Solitaire Flow Restoration With the Intention for Thrombectomy (SWIFT) multicenter randomized trial, overall and according to reperfusion status after MT.

Methods: We analyzed the relationships between the presenting glucose level as a continuous variable and presenting hyperglycemia (>140 mg/dL glucose) as a binary variable and several outcomes of interest. Subjects were stratified according to the completeness of reperfusion (Thrombolysis In Myocardial Ischemia scale 3 versus 0-2) after MT. Excellent outcome at 3 months was defined as a modified Rankin scale score of 0-1.

Results: Among all patients undergoing MT, patients with hyperglycemia less frequently exhibited an excellent outcome at 3 months than patients without hyperglycemia, 13% versus 34%; P=0.01. Presenting glucose levels did not differ among patients achieving complete reperfusion and incomplete reperfusion. Among patients with incomplete reperfusion, after adjustment for covariates, higher glucose levels were independently associated with worse outcome at 3 months (per 10 mg/dL increase in glucose: odds ratio for modified Rankin scale score 0-1 at 3 months 0.58, 95% confidence interval 0.34-0.99; P=0.047). In contrast, among patients with complete reperfusion, differences in presenting glucose levels by final outcome did not reach statistical significance.

Conclusions: In patients treated with MT, hyperglycemia was independently associated with worse outcome at 3 months, and the negative effects of hyperglycemia may have been exacerbated in patients with incomplete reperfusion after MT.

Clinical trial registration: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01054560.

Keywords: acute ischemic stroke; complete reperfusion; hyperglycemia; mechanical thrombectomy; stroke.