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Review
. 2025 Jan 17:15910199241306774.
doi: 10.1177/15910199241306774. Online ahead of print.

The effects of admission hyperglycemia and diabetes mellitus on mechanical thrombectomy outcomes: A systematic review and meta-analysis

Gokce Belge Bilgin  1 , Cem Bilgin  1 , Mohamed Sobhi Jabal  1 , Hassan Kobeissi  1 , Sherief Ghozy  1 , Yigit Can Senol  2 , Atakan Orscelik  3 , Ramanathan Kadirvel  4 , Waleed Brinjikji  1   4 , David F Kallmes  1 , Alejandro A Rabinstein  5
Affiliations
Review

The effects of admission hyperglycemia and diabetes mellitus on mechanical thrombectomy outcomes: A systematic review and meta-analysis

Gokce Belge Bilgin et al. Interv Neuroradiol. .

Abstract

Background: The impact of certain comorbidities on mechanical thrombectomy (MT) outcomes remains largely unexplored. Diabetes mellitus (DM) and admission hyperglycemia have been associated with poor clinical outcomes for patients treated with MT. In this study, we sought to investigate the effects of DM and admission hyperglycemia on MT outcomes.

Methods: Following PRISMA guidelines, a systematic literature search was conducted in Medline, Embase, Scopus, and Web of Science databases. Data regarding successful recanalization (modified Thrombolysis in Cerebral Infarction [mTICI] ≥2b), functional independence (modified Rankin Scale [mRS] 0-2), excellent outcomes (mRS 0-1), symptomatic intracranial hemorrhage (sICH), and mortality were extracted from the included studies. The pooled odds ratios (ORs) and their corresponding 95% confidence intervals (CIs) were calculated using random effects model.

Results: Twenty-one studies comprising 9708 patients were included. A total of 2311 patients (24%) had a history of DM, and 2026 patients (21%) had admission hyperglycemia. Admission hyperglycemia was associated with significantly lower odds of mTICI ≥2b (OR = 0.7, 95% CI = 0.55-0.89), mRS 0-2 (OR = 0.47, 95% CI = 0.41-0.53), and mRS 0-1 (OR = 0.43, 95% CI = 0.34-0.55) as compared to normoglycemic state. Patients with hyperglycemia had significantly higher rates of sICH (OR = 2.05, 95% CI = 1.66-2.54) and mortality (OR = 1.99, 95% CI = 1.58-2.52) than normoglycemic patients. Diabetes mellitus was associated with significantly high rates of mortality (OR = 1.74, 95% CI = 1.31-2.3) and lower rates of mRS 0-2 (OR = 0.60, 95% CI = 0.48-0.76) in sensitivity analyses.

Conclusion: Our results indicate that admission blood glucose levels and DM can negatively affect MT outcomes. Further research should focus on optimizing MT outcomes for these patients.

Keywords: Mechanical thrombectomy; diabetes; functional outcomes; hyperglycemia; stroke.

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Conflict of interest statement

Declaration of conflicting interestsThe author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: RK reported receiving grants from the National Institutes of Health and the National Science Foundation, nonfinancial material support from Medtronic, and research contracts from Cerenovus, Endovascular Engineering, Frontier Bio, Sensome, Endomimetics, Ancure, Neurogami Medical, MIVI Biosciences, Monarch Biosciences, Stryker, Conway Medical, Pireus Medical, and Bionaut Labs outside the submitted work. W.B. holds equity in Nested Knowledge, Superior Medical Editors, Piraeus Medical, Sonoris Medical, and MIVI Neurovascular. He receives royalties from Medtronic and Balloon Guide Catheter Technology. He receives consulting fees from Medtronic, Stryker, Imperative Care, Microvention, MIVI Neurovascular, Cerenovus, Asahi, and Balt. He serves in a leadership or fiduciary role for MIVI Neurovascular, Marblehead Medical LLC, Interventional Neuroradiology (Editor in Chief), Piraeus Medical, and WFITN. DFK reported receiving nonfinancial support from Nested Knowledge during the conduct of the study. In addition, DFK reported receiving grant support from MicroVention, Medtronic, Balt, Insera Therapeutics, Stryker, and Cerenovus; holding equity in Nested Knowledge, Superior Medical Editors, Conway Medical, Marblehead Medical, and Piraeus Medical; serving on the Vesalio data and safety monitoring board; and receiving royalties from Medtronic outside the submitted work. AR, grant for investigator initiated project from Chiesi; CEC committee for Boston Scientific, Advisory boards for Astra Zeneca, Novo Nordisk, Shionogi, Brainomix; leadership role for Life Source (unpaid). No other disclosures were reported.

Figures

Figure 1.
Figure 1.
PRISMA flowchart.
Figure 2.
Figure 2.
Forest plot showing successful recanalization associated with admission glucose levels.
Figure 3.
Figure 3.
(a) Forest plot showing favorable neurological outcomes associated with admission glucose levels. (b) Forest plot showing excellent neurological outcomes associated with admission glucose levels.
Figure 4.
Figure 4.
(a) Forest plot showing symptomatic intracranial hemorrhage associated with admission glucose levels. (b) Forest plot showing mortality associated with admission glucose levels.
Figure 5.
Figure 5.
(a) Forest plot showing favorable neurological outcomes associated with diabetes mellitus history. (b) Forest plot showing heterogeneity adjusted favorable neurological outcomes associated with diabetes mellitus history.
Figure 6.
Figure 6.
(a) Forest plot showing mortality associated with diabetes mellitus history. (b) Forest plot showing heterogeneity adjusted mortality associated with diabetes mellitus history.
See this image and copyright information in PMC

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References

    1. Goyal M, Menon BK, van Zwam WH, et al. Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials. Lancet 2016; 387: 1723–1731. - PubMed
    1. Williams LS, Rotich J, Qi R, et al. Effects of admission hyperglycemia on mortality and costs in acute ischemic stroke. Neurology 2002; 59: 67. - PubMed
    1. Chamorro Á, Brown S, Amaro S, et al. Glucose modifies the effect of endovascular thrombectomy in patients with acute stroke. Stroke 2019; 50: 690–696. - PubMed
    1. Goyal N, Tsivgoulis G, Pandhi A, et al. Admission hyperglycemia and outcomes in large vessel occlusion strokes treated with mechanical thrombectomy. J Neurointerv Surg 2018; 10: 112–117. - PubMed
    1. Carlos P-V, Ricardo AD, Shashwat T, et al. Influence of glucose levels on clinical outcome after mechanical thrombectomy for large-vessel occlusion: a systematic review and meta-analysis. J Neurointerv Surg 2022; 14: neurintsurg-2021-017771. - PubMed

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