Stress hyperglycemia as a modifiable predictor of futile recanalization in patients undergoing mechanical thrombectomy for acute ischemic stroke

Frontiers in Neurology

Neurology

Lorenzo Nesi¹  Roberto Sartor¹  Sara Pez¹  Yan Tereshko¹  Fedra Kuris¹  Mariarosaria Valente²  Gian Luigi Gigli³  Alessandro Vit⁴  Vladimir Gavrilovic⁴  Andrea Pellegrin⁴  Annarita Dapoto⁴  Nicola Marotti⁴  Alessandro Pauro⁴  Massimo Sponza⁴  Simone Lorenzut⁵  Giovanni Merlino⁶  Francesco Janes⁶ 

[1] Clinical Neurology, Udine University Hospital, Udine, Italy;Clinical Neurology, Udine University Hospital, Udine, Italy;Dipartimento di Area Medica (DAME), University of Udine, Udine, Italy;Dipartimento di Area Medica (DAME), University of Udine, Udine, Italy;Division of Vascular and Interventional Radiology, Udine University Hospital, Udine, Italy;Stroke Unit, Department of Head-Neck and Neuroscience, Udine University Hospital, Udine, Italy;Stroke Unit, Department of Head-Neck and Neuroscience, Udine University Hospital, Udine, Italy;Clinical Neurology, Udine University Hospital, Udine, Italy;

关键词: stress hyperglycemia;    mechanical thrombectomy;    large vessel occlusion;    acute ischemic stroke;    futile recanalization;   

DOI  :  10.3389/fneur.2023.1170215

 received in 2023-02-20, accepted in 2023-05-03,  发布年份 2023

来源: Frontiers

【 摘 要 】

IntroductionMechanical thrombectomy (MT) is the first line treatment in acute ischemic stroke (AIS) due to large vessel occlusion (LVO). Approximately half of patients treated with MT does not have a favorable outcome 3 months after stroke. The aim of this study was to identify predictors of futile recanalization (FR) in patients with LVO treated with MT.MethodsA retrospective analysis of consecutive patients with acute ischemic stroke due to anterior circulation LVO who underwent MT. Patients with a TICI score of 2b or 3 were included. We distinguished two groups, FR and meaningful recanalization (MR), according to patients' disability three months after stroke (FR: mRS score > 2; MR: mRS score < 2).ResultsWe enrolled 238 patients (FR, n = 129, 54.2%; MR, n = 109, 45.8%). Age (OR 1.05, 95% CI 1.01–1.09, p = 0.012), female sex (OR 2.43, 95% CI 1.12–5.30, p = 0.025), stress hyperglycemia, as measured by the GAR index, (OR 1.17, 95% CI 1.06–1.29, p = 0.002), NIHSS at admission (OR 1.15, 95% CI 1.07–1.25, p = 0.001) and time from symptoms onset to MT (OR 1.01, 95% CI 1.00–1.01, p = 0.020) were independent predictors of FR. The AUC for the model combining age, female sex, GAR index, NIHSS at admission and time from symptoms onset to MT was 0.81 (95% CI 0.76–0.87; p < 0.001). The optimal GAR index cut-off score to predict FR was 17.9.DiscussionFR is common after MT. We recognized older age, female sex and baseline NIHSS as non-modifiable predictors of FR. On the other hand, time from symptoms onset to MT and stress hyperglycemia were modifiable pre- and post-MT factors, respectively. Any effort should be encouraged to reduce the impact of these modifiable predictors.

【 授权许可】

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Copyright © 2023 Merlino, Pez, Sartor, Kuris, Tereshko, Nesi, Lorenzut, Janes, Sponza, Gavrilovic, Marotti, Pellegrin, Dapoto, Vit, Pauro, Gigli and Valente.