Prestroke Glucose Control and Functional Outcome in Patients With Acute Large Vessel Occlusive Stroke and Diabetes After Thrombectomy.

Abstract

To evaluate whether prestroke glucose control is associated with functional outcomes in patients with acute large vessel occlusive stroke and diabetes who underwent intra-arterial thrombectomy (IAT). From the Clinical Research Center for Stroke-Korea registry, we included patients with emergent large vessel occlusive stroke with diabetes who underwent IAT between January 2009 and March 2020. The association between the HbA_1c level at admission and functional outcomes (modified Rankin Scale at 3 months after the index stroke) was assessed. A total of 1,351 patients were analyzed. Early neurological deterioration was more common in patients with higher levels of HbA_1c at admission (<i>P</i> = 0.02 according to HbA_1c quintiles, <i>P</i> = 0.003 according to an HbA_1c cutoff value of 7.0%) than in those with lower HbA_1c levels. Higher HbA_1c levels at admission were significantly associated with decreased odds of favorable functional outcomes at a threshold of 7.0-7.1%. The association was consistently observed in subgroups divided according to age, sex, stroke subtype, occlusion site, degree of recanalization, thrombolysis modalities, time from symptom onset to groin puncture, and treatment period. Prestroke glucose control with a target HbA_1c of ≤7.0% may be beneficial for neurological recovery in patients with diabetes undergoing IAT for large vessel occlusive stroke, regardless of stroke subtype, bridging intravenous thrombolysis, occlusion site, degree of recanalization, and treatment period.