Effect of HbA1c Elevation, Glycemic Control Following Mechanical Thrombectomy: David Baker, DO


The vascular neurologist at Cleveland Clinic provided an overview of a study that assessed the extent HbA1c impacts the relationship between mechanical thrombectomy and poor outcomes. [WATCH TIME: 3 minutes]

WATCH TIME: 3 minutes

"One of the interesting findings is that we didn’t see a clear influence on hemorrhagic transformation in those with HbA1c greater than 6.5; however, when we stratified it and looked at that very poor glycemic control, that’s where we saw the impact on hemorrhagic transformation."

Blood glucose is often elevated in acute stroke, and higher admission glucose levels are associated with larger lesions, greater mortality and poorer functional outcome. Previous studies have shown that hyperglycemia is an independent predictor of hemorrhagic transformation and poor clinical outcome in patients undergoing mechanical thrombectomy (MT); however, it is less clear to what extent HbA1c impacts these relationships. At the 2023 International Stroke Conference (ISC), a group of investigators from Cleveland Clinic assessed the association between severity of poor glycemic control, functional independence, and hemorrhagic transformation.

Conducted between January 2016 and January 2022, the analysis included 657 patients who underwent MT for large vessel occlusion. Among these, the observed HbA1c value was less than 6.5 mg/dl (n = 535), 6.5-8.0 mg/dl (n = 72), or greater than 8.0 mg/dl (n = 50), with good glycemic control described as HbA1c less than 6.4 mg/dl. Above all, suboptimal glucose control and diabetes was associated with worse outcomes, its effect on hemorrhagic transformation risk was only seen in those with poor glycemic (HbA1c > 8.0) in the single center analysis.

Following these findings, NeurologyLive® sat down with lead investigator David Baker, DO, to discuss the reasons for the study, and some of the top-line findings the clinical community should be aware of. Baker, a vascular neurologist at Cleveland Clinic, expressed why the small differences in glycemic control can make a major impact on the outcomes for patients with acute ischemic stroke.

1. Baker D, Hussain M, Toth G. Risk of hemorrhagic transformation is related to severity of HbA1c elevation in patients undergoing mechanical thrombectomy. Presented at: 2023 International Stroke Conference; February 8-10; Dallas, TX.
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