Higher Blood Glucose Is Associated with the Severity of Hemorrhagic Transformation After Endovascular Therapy for Stroke

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Higher Blood Glucose Is Associated with the Severity of Hemorrhagic Transformation After Endovascular Therapy for Stroke

• Yasmin N Aziz, MD
• Vaibhav Vagal, BS
• Tapan Vijaykumar Mehta, MD, MPH
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• Shadi Yaghi, MD
• Pooja Khatri, MD, MSc
• Eva A Mistry, MBBS, MSCI
• Show all authors

Published:June 14, 2024DOI:https://doi.org/10.1016/j.jstrokecerebrovasdis.2024.107823

Highlights

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  Large vessel occlusion stroke may be particularly vulnerable to the effects of hyperglycemia.
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  We analyzed intracerebral hemorrhage severity as a result of hyperglycemia-induced toxicity.
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  Increasing blood glucose was associated with increasing severity of intracerebral hemorrhage.
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  Future study is needed to determine if glycemic control improves outcomes in this population.

ABSTRACT

Objectives

Hyperglycemia is associated with poor outcome in large vessel occlusion (LVO) stroke, with mechanism for this effect unknown.

Materials and Methods

We used our prospective, multicenter, observational study, Blood Pressure After Endovascular Stroke Therapy (BEST), of anterior circulation LVO stroke undergoing endovascular therapy (EVT) from 11/2017-7/2018 to determine association between increasing blood glucose (BG) and intracerebral hemorrhage (ICH). Our primary outcome was degree of ICH, classified as none, asymptomatic ICH, or symptomatic ICH (≥4-point increase in National Institutes of Health Stroke Scale [NIHSS] at 24 hours with any hemorrhage on imaging). Secondary outcomes included 24-hour NIHSS, early neurologic recovery (ENR, NIHSS 0-1 or NIHSS reduction by ≥8 within 24 hours), and 90-day modified Rankin Scale (mRS) using univariate and multivariable regression.

Results

Of 485 enrolled patients, increasing BG was associated with increasing severity of ICH (adjusted OR, aOR 1.06, 95% CI 1.02-1.1, p<0.001), higher 24-hour NIHSS (aOR 1.22, 95% CI 1.11-1.34, p<0.001), ENR (aOR 0.90, 95% CI 0.82-1.00, p<0.002), and 90-day mRS (aOR 1.06, 95% CI 1.03-1.09, p<0.001) when adjusted for age, presenting NIHSS, ASPECTS, 24-hour peak systolic blood pressure, time from last known well, and successful recanalization.

Conclusions

In the BEST study, increasing BG was associated with greater odds of increasing ICH severity. Further study is warranted to determine whether treatment of will decrease ICH severity following EVT.