The relationship of functional outcome after mechanical thrombectomy and serum glucose is partially mediated by edema formation

ABSTRACT

IntroductionHigh blood glucose was shown to be associated with worse clinical outcome and increased edema formation in patient with acute stroke undergoing mechanical thrombectomy.1 A better understanding of the pathophysiological pathways and a quantification of their effects might support targeted therapeutic approaches.Aim of the StudyTo quantify the amount of outcome deterioration explained by edema formation due to high blood glucose.Methods124 patients with acute ischemic stroke who underwent mechanical thrombectomy were included. Mediation analysis was performed to quantify the amount of outcome deterioration (probability for mRS>2) explained by edema formation in patients with high blood glucose. In addition, the moderating effects of good and poor collaterals were investigated.ResultsProbability for poor outcome increased with increasing blood glucose levels (OR 1.23/10 mg/dl), edema formation (OR 1.13/% net water uptake) and poor collaterals (OR 1.64). Edema formation was also associated with higher blood glucose levels (regression coefficient 0.033). An increase of blood glucose levels from 100mg/dl to 200mg/dl resulted in a 47 percentage-points decrease of the probability of good outcome in patients with good collaterals and a 26 percentage points decrease in patients with poor collaterals. Edema formation explained 15% of the outcome deterioration caused by higher blood glucose levels.ConclusionEdema formation explains 15% of the total adverse effects of high blood glucose levels. Major pathways might include other direct effects of high blood glucose, such as altered vessel wall and thrombus characteristics and higher thrombogenicity of the cerebral blood flow.ReferencesThorén, M., et al. “Predictors for Cerebral Edema in Acute Ischemic Stroke Treated with Intravenous Thrombolysis.” Stroke 2017;48(9) 2464–2471.Do you have any conflict of interest to declare? YesHelge Kniep is a consultant for Eppdata.Jens Fiehler received research support from German Ministry of Science and Education (BMBF), German Ministry of Economy and Innovation (BMWi), German Research Foundation (DFG), European Union (EU), Hamburgische Investitions- und Förderbank (IFB), Medtronic, Microvention, Route92, Stryker. He is consultant for Acandis, Bayer, Cerenovus, Covidien, Medtronic, Microvention, Penumbra, Phenox, Stryker and stock holder of Tegus Medical.