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  • Influence of glucose levels on clinical outcome after mechanical thrombectomy for large-vessel occlusion: a systematic review and meta-analysis

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Ischemic stroke
Review
Influence of glucose levels on clinical outcome after mechanical thrombectomy for large-vessel occlusion: a systematic review and meta-analysis
  1. Carlos Perez-Vega1,
  2. Ricardo A Domingo1,
  3. Shashwat Tripathi1,2,
  4. Andres Ramos-Fresnedo1,
  5. Samir Kashyap3,
  6. Alfredo Quinones-Hinojosa1,
  7. Michelle P Lin4,
  8. W Christopher Fox1,
  9. Rabih G Tawk1
  1. 1 Department of Neurologic Surgery, Mayo Clinic, Jacksonville, Florida, USA
  2. 2 Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
  3. 3 Department of Neurosurgery, Riverside University Health System, Riverside, California, USA
  4. 4 Department of Neurology, Mayo Clinic, Jacksonville, Florida, USA
  1. Correspondence to Dr Rabih G Tawk, Department of Neurosurgery, Mayo Clinic, Jacksonville, Florida FL 32224, USA; tawk.rabih{at}mayo.edu

Abstract

Mechanical thrombectomy (MT) represents the mainstay of treatment for patients with acute ischemic stroke due to large-vessel occlusion (LVO). Intravenous thrombolysis has been associated with worse clinical outcome in patients presenting with high blood glucose levels at admission; to date the true effect of hyperglycemia in the setting of MT has not been fully elucidated. In this meta-analysis, we analyzed the influence of high blood glucose levels at admission on clinical outcome after MT. Ovid EMBASE, PubMed, Scopus, and Cochrane Library databases were searched from their dates of inception up to March 2021. An initial search identified 2118 articles representing 1235 unique studies. After applying selection criteria, three prospective and five retrospective studies were analyzed, yielding a pooled cohort of 5861 patients (2041 who presented with hyperglycemia, and 3820 who presented with normal blood glucose levels). Patients in the hyperglycemia group were less likely to have a modified Ranking Scale (mRS) score <3 (risk ratio (RR): 0.65; 95% CI 0.59 to 0.72; p<0.0001; I 2=13%), and had an increased risk of symptomatic intracranial hemorrhage (sICH) (RR: 2.07; 95% CI 1.65 to 2.60; p<0.0001; I 2=0%) and mortality (RR: 1.73; 95% CI 1.57 to 1.91; p<0.0001; I 2=0%). Patients who present with hyperglycemia and undergo MT for treatment of LVO have an increased risk of unfavorable clinical outcome, sICH, and mortality. Glucose levels at admission appear to be a prognostic factor in this subset of patients. Further studies should focus on evaluating control of the glucose level at admission as a modifiable risk factor in patients undergoing MT for LVO.

  • Stroke
  • Thrombectomy
  • Intervention

https://doi.org/10.1136/neurintsurg-2021-017771

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    Footnotes

    • Twitter @carlosperezv, @wchrisfox

    • Contributors RGT had the idea for the article. CP-V, RAD, ST, and AR-F performed the literature review, data collection, data analysis, and writing of the article. RGT, WCF, MPL, AQ-H, and SK performed critical evaluation, writing of the article evaluation, and revised the final version.

    • 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.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.