Short-term glycemic variability and hemorrhagic transformation after successful endovascular thrombectomy

Abstract

Background

Glycemic variability (GV) is a risk factor for poor outcomes after ischemic stroke. However, its effect on hemorrhagic transformation after endovascular recanalization therapy (ERT) remains to be elucidated.

Methods

Patients with acute ischemic stroke due to large vessel occlusion with successful recanalization after ERT (modified thrombolysis in cerebral infarction 2b or 3) were enrolled between January 2013 and November 2019. Blood glucose level data were obtained during the first 36 h after ERT, and ten GV parameters including time rate (TR) of glucose variation were assessed. The TR of glucose variation reflects the speed of glucose fluctuations over time (mg/dL/hour) during the monitoring period. Symptomatic intracerebral hemorrhage (sICH) and unfavorable outcomes at 3 months after ERT were analyzed. The sICH was defined as parenchymal hematoma type 2 with a neurological deterioration of 4 points or more on the National Institute of Health Stroke Scale. Moreover, a modified Rankin Scale of 3–6 at 3 months was considered an unfavorable outcome.

Results

Among all patients (n = 176; mean age, 69.3 years; 47.7 % female), sICH developed after successful ERT in 16 (9.1%) patients. In addition, 54% (n = 95) patients had an unfavorable outcome at 3 months. Patients with sICH and unfavorable outcome had higher the TR of glucose variation. After adjusting for potential confounders, the TR of glucose (per 1 mg/dL/h increase) variation was independently associated with sICH (odds ratio, 1.17; 95% confidence interval [CI], 1.012–1.343) and 3-month unfavorable outcome (OR 1.14, 95% CI, 1.000–1.297).

Conclusions

Time-related GV during the first 36 h after successful ERT has a stronger correlation with sICH and poor functional outcomes compared to any GV parameters. This suggests that maintaining stable glucose may be an important factor in the prevention of sICH after undergoing successful ERT.

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Data Availability

Data supporting the findings of this study are available from the corresponding author (Pf. Sang-Bae Ko) on reasonable request.

Code Availability

N/A.

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Affiliations

Authors

Contributions

S-B K. contributed to the study concept and design. TJ K., and JS L. contributed to data analysis. TJ K. and S-H P. contributed to data collection. TJ K. and S-B K. drafted the manuscript. All authors read and approved the manuscript.

Corresponding author

Correspondence to Sang-Bae Ko.

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Ethics Approval and Consent to Participate

The study was approved by the Institutional Review Boards (IRB) of Seoul National University Hospital (IRB No. H-1009-062-332). The need for informed consent was waived by the IRBs.

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Cite this article

Kim, T.J., Lee, J.S., Park, SH. et al. Short-term glycemic variability and hemorrhagic transformation after successful endovascular thrombectomy. Transl. Stroke Res. (2021). https://doi.org/10.1007/s12975-021-00895-4

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Keywords

  • Glycemic variability
  • Ischemic stroke
  • Successful recanalization
  • Endovascular thrombectomy
  • Symptomatic hemorrhagic transformation