Abstract A089: Association of serum glucose levels at presentation and endovascular thrombectomy outcomes in SELECT prospective cohort study

Introduction: Hyperglycemia at presentation is associated with worse clinical outcomes in patients with acute ischemic stroke receiving endovascular thrombectomy. We aimed to assess the relationship between presentation hyperglycemia and clinical and imaging outcomes in SELECT prospective cohort study. Methods: From prospectively collected thrombectomy data from 9 high volume US EVT centers, patients receiving EVT for ICA/M1/M2 occlusions were stratified based on serum glucose levels at presentation (<140 vs ≥140mg/dL, <170 vs ≥170mg/dL). Outcomes were compared between strata using appropriate regression models adjusted for age, NIHSS, occlusion location, time from last known well to procedure, thrombolytics use, ischemic core, CT ASPECTS and successful reperfusion status (mTICI2b-3). Results: Of 281 EVT patients with available data, 98 (34%) had glucose ≥140mg/dL and 59 (21%) with ≥170mg/dL. Patients with higher glucose had higher comorbidities and presented with higher NIHSS, ischemic core and critically hypoperfused tissue volumes. A significant positive correlation between ischemic core and glucose (ρ: 0.17, p<0.01) was observed. Each 10mg/dl increase in glucose was associated with 9% reduction in the odds of achieving better mRS shift (acOR: 0.91, 95% CI: 0.87-0.95, p<0.001) and 8% reduction in the odds of mRS 0-2 (aOR: 0.92, 95% CI: 0.87-0.96, p=0.001). Patients with higher glucose levels demonstrated worse mRS shift (<140mg/dL: 2 (0, 3) vs ≥140mg/dL: 4 (2, 5), acOR: 0.45, 95% CI: 0.28 to 0.73, p-value: 0.001, figure 1a, figure 2), lower mRS 0-2 (64% vs 33%, aOR: 0.35, 95% CI: 0.19 to 0.66, p-value: 0.001) and worse safety (sICH – 3% vs 13%, aOR: 4.84, 95% CI: 1.49 to 15.66, p-value: 0.009; neurological worsening: 6% vs 22%, aOR: 4.24, 95% CI: 1.74 to 10.36, p-value: 0.002). Infarct volume and growth at 24-hour follow-up were numerically larger. Similar results were observed using 170mg/dL treshold (figure 1b, figure 3). No significant interaction between ischemic core volume and serum glucose on mRS shift was observed (p-int: 0.11). Conclusions: Higher serum glucose at presentation was frequent, associated with larger ischemic core and had worse functional outcomes and safety among patients receiving EVT, without significant glucose-ischemic core interaction. Further examination of pathways mediating effect of higher glucose as well as potential mechanisms to reduce effect of serum glucose may help further optimize EVT outcomes.