The Impact of Blood Glucose Levels on the Prognosis of Diabetic Patients With Successful Recanalization After Mechanical Thrombectomy: A Single-Center Retrospective Study

Objective: To investigate the impact of postoperative fasting blood glucose monitoring on the prognosis of patients with acute intracranial large vessel occlusion (ALVO) after mechanical thrombectomy. Methods: A retrospective study was conducted on 328 diabetic patients diagnosed with acute ischemic stroke through MRI, confirmed to have intracranial large vessel occlusion through MRA or DSA, and treated with mechanical thrombectomy between June 2021 and June 2023 at Tianjin Huanhu Hospital. Based on the 90-day postonset prognosis (modified Rankin scale, 90d-mRS), 148 patients were categorized into the favorable prognosis group (90d-mRS score 0–2) and 180 into the poor prognosis group (90d-mRS 3–6). Clinical data between the 2 groups were compared. Factors with P <0.1 in univariate analysis were included in multivariate Logistic regression analysis to evaluate their impact on prognosis. Results: A total of 328 diabetic patients were included in the study, with a median age of 63 (56, 69) years; 240 males aged 60.88 (55, 68.75) years and 88 females aged 65.16 (60, 72) years. There were significant differences between the 2 groups in terms of gender, preoperative mRS, and fasting blood glucose within the first 3 days postoperation. Multivariate Logistic regression analysis indicated that gender, preoperative mRS score, and fasting blood glucose on the first postoperative day were independent risk factors for poor prognosis. Female diabetic patients had a 56.7% higher rate of poor prognosis compared with males patients (OR: 0.567, 95% CI: 0.326–0.986, P =0.044); the poor prognosis rate in the preoperative mRS 3 to 6 group was 2.101 times that of the preoperative mRS 0 to 2 group (OR: 2.101, 95% CI: 1.027–4.300, P =0.042); for every 1 mmol/L increase in fasting blood glucose on the first day post-thrombectomy was associated with a 10.2% increase in the rate of poor prognosis at 90 days (OR: 1.102, 95% CI: 1.023–1.189, P =0.011). The predictive power of fasting blood glucose on the first postoperative day for 90d-mRS was greater than that of gender and preoperative mRS, with sensitivity and specificity of 68.2% and 60.6%, respectively. Combined prediction using fasting blood glucose, gender, and preoperative mRS had similar effectiveness. Maintaining fasting blood glucose levels below 11.5 mmol/L on the first day post-thrombectomy could reduce the rate of poor prognosis in patients. Conclusion: Fasting blood glucose levels on the first day post-thrombectomy can be used as a prognostic indicator for diabetic patients with acute intracranial large vessel occlusion. Effective blood glucose control can significantly reduce the rate of poor prognosis in these patients.