Delayed neurological recovery in ischemic stroke patients undergoing endovascular treatment is associated with baseline hyperglycemia: a treatable cause of the stunned brain phenomenon?

BACKGROUND AND AIMS

In ischemic stroke, there is limited data regarding the impact of baseline hyperglycemia on the treatment effect of recanalization on neurological recovery. This study aimed to directly compare-how short- and long-term serum glucose levels modify the effect of recanalization on functional outcome in patients with ischemic stroke and specifically analyze the occurrence of delayed neurological recovery ("stunned brain phenomenon").

METHODS

Observational retrospective analysis including patients with anterior circulation ischemic stroke and large vessel occlusion undergoing mechanical thrombectomy following multimodal-CT upon admission. The primary endpoint was delayed neurological recovery, defined as a lack of early neurological improvement (ENI) at 24 h despite achieving functional independence at day 90. Binary ENI was defined as 24 h-NIHSS ≤ 8 points. The treatment effect of recanalization defined as mTICI 2b-3 was determined for patients with high versus low serum blood glucose (BG, cut-off: 140 mg/dl). Inverse-probability weighting analysis (IPW) was used to assess the treatment effect of recanalization according to glucose profiles.

RESULTS

A total of 348 patients were included in the analysis. The treatment effect of recanalization in patients with low BG on the NIHSS at 24 h and binary ENI was  - 3.5 (95%CI  - 5.3 to  - 1.8, p < 0.001) and 22.4% (95%CI 13.1-31.8, p < 0.001). Furthermore, recanalization in patients with low BG was associated with functional independence at day 90 (26.4%, 95%CI 17.1-35.8, p < 0.001). For patients with high BG, recanalization was not associated with a lower NIHSS at 24 h ( - 1.4, 95%CI  - 3.7-0.9, p = 0.24) although significantly being associated with functional independence at day 90 (+ 14.7%, 95%CI 4.5-24.9, p = 0.005).

DISCUSSION

Successful vessel recanalization was associated with better functional outcome at day 90 independent of BG profiles; however, acute hyperglycemia was significantly linked to delayed neurological recovery. Hence, hyperglycemia might be a major cause of the stunned brain phenomenon and might consequently serve as a promising target for adjunctive therapy in the treatment of ischemic stroke patients.