• World Neurosurg · Jan 2025

    Stress hyperglycemia could influence futile recanalization in patients who undergo mechanical thrombectomy for stroke caused by large vessel occlusion.

    • Yuichiro Tsuji, Hideki Kashiwagi, Masao Fukumura, Gen Futamura, Ryokichi Yagi, Ryo Hiramatsu, and Masahiko Wanibuchi.
    • Department of Neurosurgery, Osaka Medical and Pharmaceutical University, Takatsuki, Osaka, Japan; Department of Neurosurgery, Kano General Hospital, Osaka, Osaka, Japan. Electronic address: yuuichirou.tsuji@ompu.ac.jp.
    • World Neurosurg. 2025 Jan 19: 123697123697.

    BackgroundMechanical thrombectomy (MT) has become the standard treatment for acute ischemic stroke caused by large vessel occlusion (LVO). Despite successful recanalization, approximately one-half of the patients do not achieve a favorable outcome, which is known as "futile recanalization" (FR). The present study aimed to explore the association between stress hyperglycemia and FR after MT.MethodsData from 224 eligible patients with LVO, who underwent MT at the authors' hospital between January 2015 and December 2023, were retrospectively reviewed. Patients were divided into FR group and non-FR groups according to functional independence at 3 months according to a modified Rankin scale. Factors influencing FR were identified using multivariate regression and a receiver operating characteristic (ROC) curve analyses.ResultsFR was observed in 40 (38.4%) of 104 patients who fulfilled the inclusion criteria. Multivariable regression analysis revealed that older age (odds ratio [OR] 1.09 [95% confidence interval (CI) 1.03-1.15]; P=0.001), an increased number of passes (OR 1.57 [95% CI 1.03-2.40]; P=0.034), and a greater stress hyperglycemia ratio (SHR) (OR 16.0 [95% CI 1.49-172.8]; P=0.021) were independently associated with FR after MT. ROC curve analysis revealed that a model of combining age, SHR, Diffusion-Weighted Imaging-Alberta Stroke Program Early Computed Tomography Scores, procedure duration, systolic blood pressure, and number of passes (area under the ROC curve, 0.83, [P<0.01]) was accurate.ConclusionsResults of this study revealed that older age, an increased number of passes, and greater SHR were independently associated with FR after MT in patients with acute ischemic stroke caused by LVO.Copyright © 2025 The Author(s). Published by Elsevier Inc. All rights reserved.

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