ABSTRACT NUMBER: ESOC2026A2023 MECHANICAL THROMBECTOMY IN PATIENTS WITH LONG-TERM HYPERGLYCEMIA: INSIGHTS FROM THE EVA-TRISP COHORT

Abstract Background and aims Acute hyperglycemia impairs recovery in patients undergoing endovascular therapy (EVT) for large vessel occlusion (LVO) stroke. The impact of long-term hyperglycemia is less well understood. We aimed to assess whether long-term hyperglycemia impacts clinical and safety outcomes in patients undergoing EVT. Methods Retrospective observational study including patients ≥18 years undergoing EVT between 2014 and 2023 within the ongoing international EVA-TRISP registry. Long-term hyperglycemia was assessed using HbA1c. Primary outcome was functional status at three months (assessed by modified Rankin Scale (mRS) shift). Safety outcomes were symptomatic intracranial hemorrhage (sICH) at 24 hours (ECASS-II) and death at three months. Ordinal and binary logistic regression models were conducted, using HbA1c (%) as continuous variable, adjusting for age, sex, center, pre-stroke mRS, NIHSS, intravenous thrombolysis and time from last-seen-well to hospital admission. Results We included 2,625 patients from 11 centers (median age 73 yrs (IQR 74–81), 47.5% female, median NIHSS 14 pts (IQR 8–18)). 1,378 patients (52%) had HbA1c <5.7%, 827 (32%) patients HbA1c 5.7%–6.4%, and 420 patients (16%) HbA1c ≥6.5%. Higher HbA1c levels were associated with lower odds of functional recovery at three months (adjusted common OR 0.87 (95%-CI 0.81–0.93 per +1% HbA1c)). Rates of sICH did not differ (aOR 1.11 (95%-CI 0.95–1.30 per +1% HbA1c). HbA1c was independently associated with death at three months (aOR 1.18 (95%-CI 1.06–1.31) per +1% HbA1c). Conclusions Long-term hyperglycemia may impact functional recovery after MT. Effective diabetic control could help mitigate the deleterious effect of LVO stroke. Conflict of interest Christoph Riegler: nothing to disclose. Sami Curtze: nothing to disclose. Joao Pedro Marto: nothing to disclose. Susanne Wegener: nothing to disclose. Mirjam R Heldner: nothing to disclose. Gian Marco de Marchis: nothing to disclose. Henrik Gensicke: nothing to disclose. Carlo W Cereda: nothing to disclose. Visnja Padjen: nothing to disclose. Christian H Nolte: nothing to disclose.