Abstract Details

Title The Effects of Hyperglycemia in Diabetic and Non-Diabetic Patients on Collateral Circulation with Large Vessel Occlusions Undergoing Mechanical Thrombectomy: A Single Center Experience

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) S17 - Cerebrovascular Disease: Clinical Trials and Outcomes Studies (4:06 PM-4:18 PM)

Poster/Presentation
Number 004

Background

Diabetes and hyperglycemia are major risk factors in the development of ischemic strokes. They lead to expansion of infarcted brain volume and contribute to poor outcomes. In the case of acute large vessel occlusion ischemic strokes, the degree of collateral blood flow is also a major factor in treatment decisions and predicting outcomes. Individually, hyperglycemia and poor collaterals lead to worse outcomes in acute stroke patients, however, their relationship is not well understood.

Objective Our study aim was to investigate hyperglycemia effect on collaterals in patients large vessel occlusions (LVO) undergoing mechanical thrombectomy (MT) with or without diabetes.

Design/Methods IRB approval was obtained for a retrospective analysis of consecutive LVO patient data treated with MT at a Comprehensive Stroke Center in the Mid-South. Included were adult patients with LVO on CTA and treated with MT within 24 hours of symptom onset.

Results A total of 450 patients underwent MT out of which 433 had baseline HbA1c recorded: mean age 64±15 years, 47% women, pre-treatment NIHSS median 15 points IQR 10-19, 323 (75%) with good collaterals grades >2 on multiphasic CTA, 326 (75%) were non-diabetic, and 107 (25%) were diabetic. Non-diabetics with stress hyperglycemia had a trend towards higher NIHSS scores pre-treatment (median 18 IQR 12-22 vs median 16 IQR 11-19, p=0.061) and at 24-hours (median 12 IQR 12-17 vs 10 IQR 4-15, p=0.056), poor collaterals (multiphasic CTA score ≥2; 34.5% vs 21.5%, p=0.049), and larger infarct volumes (50.7±63.6 vs 24.4 ±33.8 cc, p<0.0001) when compared to non-diabetics without stress hyperglycemia. For every 1mg/dL increase in admission blood glucose there was a 0.3 cc increase in infarct volume (95% CI for β 0.2-0.4; p<0.0001) after adjusting for the final TICI score.

Conclusions LVO patients with stress hyperglycemia without previously diagnosed diabetes had more severe strokes, poorer collaterals and developed larger infarct volumes post mechanical thrombectomy.

Authors/Disclosures
Brittany M. Kasturiarachi, DO (University of Cincinatti) PRESENTER	Dr. Kasturiarachi has received personal compensation in the range of $0-$499 for serving as a Social Media Ambassador with True Learn.
Omar Saeed, MD (Mary Washington hospital)	Dr. Saeed has nothing to disclose.
Leila Gachechiladze, MD (OU Health/University of Oklahoma)	Dr. Gachechiladze has nothing to disclose.
Diana Alsbrook, MD (University of Maryland Medical Center)	Dr. Alsbrook has nothing to disclose.
Savdeep Singh, MD (Savdeep Singh)	Dr. Singh has nothing to disclose.
Ghaida K. Zaid, MD	Dr. Zaid has nothing to disclose.
Prasanna Venkatesan Eswaradass, MD (University of Kansas Health System)	Dr. Eswaradass has nothing to disclose.
Cheran Elangovan, MD (University of Tennessee Health Science Center)	Dr. Elangovan has nothing to disclose.
Marc Malkoff, MD, FAAN (University of Tennessee)	Dr. Malkoff has nothing to disclose.
	No disclosure on file
Balaji Krishnaiah, MD, FAAN (University of Tennessee Health Sciences Center)	Dr. Krishnaiah has received publishing royalties from a publication relating to health care.
Andrei V. Alexandrov, MD (Department of Neurology, UTHSC)	The institution of Dr. Alexandrov has received personal compensation in the range of $500-$4,999 for serving as a Consultant for NovaSignal. Dr. Alexandrov has received personal compensation in the range of $500-$4,999 for serving as a Consultant for NovoNordisc. Dr. Alexandrov has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for AstraZeneca. Dr. Alexandrov has received personal compensation in the range of $0-$499 for serving as an officer or member of the Board of Directors for American Society of Neuroimaging. Dr. Alexandrov has received publishing royalties from a publication relating to health care.