Abstract 1122‐000119: Impact of Diabetes on Pass‐Number in Intracranial Thrombectomy for Large Vessel Occlusion Acute Ischemic Stroke

Introduction : Admission hyperglycemia is associated with poor functional outcomes, greater hemorrhagic risk and mortality after endovascular therapy (EVT) for large vessel occlusion (LVO) acute ischemic stroke (AIS). Diabetes is also linked with intracranial atherosclerosis. In this study, we examine whether underlying diabetes is associated with increased pass number requirements, as a possible etiology for worsened clinical outcomes in these patients. Methods : From our prospectively maintained multi‐institutional registry across 4 comprehensive stroke centers, we identified patients with LVO AIS undergoing EVT, for whom admission glucose, HbA1c as well as complete procedural details and 90 day outcome measures (mRS) had been captured. Diabetes was defined using HbA1c cutoff of ≥ 6.5% consistent with American Diabetes Association definitions. Admission hyperglycemia was defined as serum glucose on admission of >140 mg/dL. The primary outcome was number of EVT passes required for TICI ≥2b in diabetic vs. non‐diabetic patients. Results : Among 512 patients that met inclusion criteria, median age was 68 [IQR 58‐78], 254 (49.6%) were female, and median NIHSS was 16 [IQR 11‐20]. Median HbA1c was 5.8% (range 2.5‐14%), and 136 (26.6%) were diabetic. Mean admission glucose was greater in diabetic patients (122±30.7 vs. 199±79.8 mg/dL, non‐diabetic vs. diabetic, p<0.01). Admission hyperglycemia and HbA1≥6.5 were associated with lower rates of 90 day mRS 0–2 (24.0% vs 42.7%, hyperglycemia vs. no hyperglycemia, p<0.01; 28.7% vs. 39.1%, diabetes vs. no diabetes, p = 0.03). However, diabetics and patients presenting with hyperglycemia did not appear to require a higher number of passes to achieve TICI 2b or greater (1.83 vs 1.88, p = 0.69, 1.82 vs 1.88, p = 0.56, respectively) and had comparable first pass recanalization rates (56 vs 53%, p = 0.50, 56 vs 54, p = 0.72). Conclusions : Presentation hyperglycemia and diabetes were both associated with worsened clinical outcomes, but not with increased pass numbers or procedural time in EVT. These findings suggest alternative means by which clinical outcomes are worsened in this population.