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Ischemic Stroke
Original research
Glycated hemoglobin (HbA1c) and outcome following endovascular thrombectomy for ischemic stroke
  1. William K Diprose1,2,
  2. Michael T M Wang1,
  3. Andrew McFetridge3,
  4. James Sutcliffe3,
  5. P Alan Barber1,2
  1. 1 Department of Medicine, University of Auckland, Auckland, New Zealand
  2. 2 Department of Neurology, Auckland City Hospital, Auckland, New Zealand
  3. 3 Department of Radiology, Auckland City Hospital, Auckland, New Zealand
  1. Correspondence to Professor P Alan Barber, Department of Medicine, University of Auckland, Auckland 1010, New Zealand; a.barber{at}auckland.ac.nz

Abstract

Background In ischemic stroke, increased glycated hemoglobin (HbA1c) and glucose levels are associated with worse outcome following thrombolysis, and possibly, endovascular thrombectomy.

Objective To evaluate the association between admission HbA1c and glucose levels and outcome following endovascular thrombectomy.

Methods Consecutive patients treated with endovascular thrombectomy with admission HbA1c and glucose levels were included. The primary outcome was functional independence, defined as a modified Rankin Scale score of 0–2 at 3 months. Secondary outcomes included successful reperfusion (modified Thrombolysis in Cerebral Infarction 2b-3), early neurological improvement (reduction in National Institutes of Health Stroke Scale (NIHSS) score ≥8 points, or NIHSS score of 0–1 at 24 hours), symptomatic intracerebral hemorrhage (sICH), and mortality at 3 months.

Results 223 patients (136 (61%) men; mean±SD age 64.5±14.6) were included. The median (IQR) HbA1c and glucose were 39 (36-45) mmol/mol and 6.9 (5.8–8.4) mmol/L, respectively. Multiple logistic regression analysis demonstrated that increasing HbA1c levels (per 10 mmol/mol) were associated with reduced functional independence (OR=0.76; 95% CI 0.60–0.96; p=0.02), increased sICH (OR=1.33; 95% CI 1.03 to 1.71; p=0.03), and increased mortality (OR=1.26; 95% CI 1.01 to 1.57; p=0.04). There were no significant associations between glucose levels and outcome measures (all p>0.05).

Conclusions HbA1c levels are an independent predictor of worse outcome following endovascular thrombectomy. The addition of HbA1c to decision-support tools for endovascular thrombectomy should be evaluated in future studies.

  • thrombectomy
  • stroke
  • hemorrhage

https://doi.org/10.1136/neurintsurg-2019-015023

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    Footnotes

    • Contributors All authors contributed to the design and implementation of the research, to the analysis of the results, and to the writing of the manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement Data are available upon reasonable request to the corresponding author a.barber@auckland.ac.nz.

    • Patient consent for publication Not required.