Clinical Outcome After Mechanical Thrombectomy in Patients with Diabetes with Major Ischemic Stroke of the Anterior Circulation

World Neurosurg. 2018 Dec:120:e212-e220. doi: 10.1016/j.wneu.2018.08.032. Epub 2018 Aug 16.

Abstract

Background: Among patients with acute ischemic stroke treated with mechanical thrombectomy (MT), patients with diabetes (DP) show a poorer outcome compared with patients without diabetes (NDP). This study aims to provide a comprehensive analysis of factors associated with unfavorable outcome in DP receiving MT for stroke of the anterior circulation.

Methods: This study included 317 of 498 consecutive patients who received interventional treatment for acute ischemic stroke in the terminal internal carotid artery and/or middle cerebral artery, including 46 DP. The study data included pre- and posttreatment stroke computed tomography, including perfusion data, collateral status, treatment data including treatment times, pre-existing cardiovascular risk factors, cerebrovascular events, comorbidities, laboratory parameters, and medication. Neurologic status was assessed at baseline (National Institute of Health Stroke Scale [NIHSS]/modified Rankin Scale [mRS]) and after 90 days (mRS 90).

Results: Compared with NDP, DP showed a significantly poorer outcome (mRS90 >2) (P < 0.05). Collateralization and infarct core size did not differ between groups, whereas the penumbra was significantly smaller in DP than in NDP (P < 0.05). The poorer mRS90 outcome (mRS90 > 2) in DP was associated with poor collaterals (P = 0.01) and hyperglycemia on admission (P < 0.05). Shorter time to reperfusion was associated with favorable mRS90 in the NDP (P < 0.001) but not the DP (P = 0.49) group. In univariate logistic regression, the following parameters were significantly associated with mRS90: diabetes, hyperglycemia at admission, time to reperfusion, and the NIHSS score (P < 0.05 each). In multivariate analyses and partition regression models of all variables, DP with admission hyperglycemia (≥132 mg/dL) and older age (≥66 years) showed a particularly poor outcome.

Conclusions: The main factors for an unfavorable outcome of DP after MT are admission hyperglycemia, age, and NIHSS score.

Keywords: Collaterals; Diabetes; Outcome; Penumbra; Stroke; Thrombectomy; Time to reperfusion.

MeSH terms

  • Age Factors
  • Aged
  • Aged, 80 and over
  • Blood Glucose / metabolism
  • Brain Ischemia / epidemiology
  • Brain Ischemia / surgery*
  • Carotid Artery, Internal / surgery*
  • Case-Control Studies
  • Collateral Circulation
  • Comorbidity
  • Diabetes Mellitus / epidemiology*
  • Diabetes Mellitus / metabolism
  • Female
  • Humans
  • Hyperglycemia / epidemiology*
  • Hyperglycemia / metabolism
  • Infarction, Middle Cerebral Artery / surgery*
  • Logistic Models
  • Male
  • Middle Aged
  • Middle Cerebral Artery / surgery
  • Multivariate Analysis
  • Severity of Illness Index
  • Stroke / epidemiology
  • Stroke / surgery*
  • Thrombectomy / methods*
  • Treatment Outcome

Substances

  • Blood Glucose