ABSTRACT NUMBER: ESOC2026A361 ADMISSION HYPERGLYCEMIA AND FUTILE RECANALIZATION AFTER ENDOVASCULAR THROMBECTOMY IN PATIENTS WITH ACUTE ISCHEMIC STROKE

Abstract Background and aims Futile recanalization (FR) remains a major clinical challenge in a substantial proportion of patients with large vessel occlusion (LVO) stroke, despite high rates of successful endovascular thrombectomy (EVT). This study aims to investigate the association between admission hyperglycemia and clinical outcomes in acute ischemic stroke patients undergoing EVT. Methods This retrospective cohort study included 1,030 consecutive patients with LVO who achieved successful recanalization after EVT. Admission hyperglycemia was defined as admission glucose ≥7.8 mmol/L. FR was defined as patients with successful recanalization (mTICI score 2b-3) who did not achieve functional independence (mRS score of 0-2 at 90 days). Secondary outcomes included early neurological deterioration (END), symptomatic intracranial hemorrhage (sICH), and 90-day mortality. Associations were assessed using multivariable logistic regression and validated using propensity score matching (PSM) sensitivity analysis. Results Among 1,030 patients, 455 presented with hyperglycemia. After adjustment, hyperglycemia was independently associated with increased risks of FR (adjusted odds ratio [aOR], 1.79; 95% CI 1.37–2.34), END (aOR, 2.02; 95% CI 1.51–2.70), and 90-day mortality (aOR, 2.41; 95% CI 1.77–3.28). No significant association with sICH was observed (aOR, 1.20; 95% CI 0.82–1.75). These associations, including the null finding for sICH, remained robust and consistent in the PSM analysis. Analysis revealed an approximately linear relationship between glucose and FR risk, whereas a J-shaped curve with a nadir near 7 mmol/L was observed for END and mortality. Conclusions Admission hyperglycemia is independently associated with increased risks of FR, END and mortality following EVT. Conflict of interest Nothing to disclose