ABSTRACT NUMBER: ESOC2026A1482 METABOLIC PREDICTORS OF FUNCTIONAL OUTCOME AFTER THROMBECTOMY FOR ANTERIOR CIRCULATION LARGE VESSEL OCCLUSION

Abstract Background and aims Glucose metabolism influences stroke recovery, but whether acute and chronic metabolic measures independently predict outcome after thrombectomy remains unclear. Skin autofluorescence (SAF), a non-invasive marker reflecting cumulative tissue advanced glycation end products (AGEs), offers potential for stratification in thrombectomy patients. We investigated whether admission blood glucose, HbA1c, and SAF predict functional outcome after thrombectomy, irrespective of diabetes status. Methods We analysed combined data from a retrospective and a prospective registry of 302 patients with acute anterior circulation large vessel occlusion undergoing thrombectomy at a German tertiary center. SAF was measured within 72 hours after admission. Primary endpoint: functional dependency at 90 days (mRS ≥ 3). We used logistic regression models adjusted for age, baseline NIHSS, ASPECTS, TICI, and intracranial hemorrhage to test admission glucose, HbA1c, and SAF. Results All metabolic markers were associated with poor outcome in unadjusted analysis (SAF (per AU): OR 1.57, 95% CI 1.13–2.18, p=0.007; glucose (per 10 mg/dL): OR 1.21, 95% CI 1.11–1.31, p<0.001; HbA1c (per 1%): OR 1.62, 95% CI 1.15–2.28, p=0.006). However, in fully adjusted models, associations were attenuated and no longer significant. TICI remained the dominant predictor of outcome. Conclusions While acute and chronic dysglycemia markers were associated with functional outcome after thrombectomy, they did not provide independent predictive value beyond established clinical and imaging markers. Interventional studies with more deeply phenotyped cohorts are needed to clarify causal mechanisms. Conflict of interest Marlene Unkelbach: nothing to disclose. Alexandra Filipov: nothing to disclose. Jessica Jesser: nothing to disclose. Martin Andermann: nothing to disclose. Peter Ringleb: nothing to disclose. Christoph Mooshage: nothing to disclose. Christoph Gumbinger: nothing to disclose. Markus Möhlenbruch: nothing to disclose.