Hyperglycemic Control in Acute Ischemic Stroke Patients Undergoing Endovascular Treatment: Post Hoc Analysis of the Stroke Hyperglycemia Insulin Network Effort Trial

Background and Purpose: Hyperglycemia has been associated with higher rates of death or disability in acute ischemic stroke patients undergoing endovascular treatment. However, it remains unclear whether intensive serum glucose reduction can reduce the rates of death or disability in patients undergoing endovascular treatment. Methods: We analyzed the effect of intensive (serum glucose <110 mg/dl) glucose treatment (compared with standard treatment, serum glucose <180 mg/dl) in patients who received endovascular treatment in the Stroke Hyperglycemia Insulin Network Effort (SHINE). We further analyzed the effect of area under the curve of serum glucose, proportion of the time blood glucose was < 140mg/dL, and glucose variability defined as glucose range during 72-hours. The primary outcomes of interest were neurological deterioration within 72 hours and outcome at 90 days. Results: A total of 146 patients (mean age 68.1±13.9, 50.7% were men) underwent endovascular treatment for acute ischemic stroke; 72 and 74 patients were randomized to intensive and standard treatments, respectively. The rates of death (20.3%, and 22.2%), favorable 90-day primary outcome (17.6% and 19.4%), and serious adverse events (41.9% and 56.98%) were similar between the two groups. The area under the curve of serum glucose was not associated with death within 90 days (OR 1, 95% CI 1-1) or favorable outcome at 90 days (OR 1, 95% CI 1-1). Glucose variability was not associated with death or favorable outcome at 90 days. Intensive treatment was not associated with cerebral hemorrhagic events. Conclusion: We did not identify any beneficial effect of intensive glucose reduction on rates of death or favorable outcomes at 90 days among acute ischemic stroke patients undergoing endovascular treatment. We also did not observe any relationship between various glycemic parameters and death or favorable outcomes at 90 days.