Patients With Diabetes Have Worse Outcomes After Mechanical Thrombectomy Than Non-Diabetic Patients

October 14, 2020

By Louise Gagnon

OTTAWA, Ontario -- October 13, 2020 -- Patients with diabetes fare worse than non-diabetic patients after undergoing mechanical thrombectomy to treat large vessel occlusion, according to a study presented at the 2020 Virtual Meeting of the American Neurological Association (ANA).

“We found that [patients with diabetes] tend to have a bad outcome following thrombectomy,” said Riwaj Bhagat, MD, University of Louisville, Louisville, Kentucky. “Diabetes causes pathological changes in large and small blood vessels, making it stiff and friable. Reperfusion after mechanical thrombectomy in patients with diabetes carries a risk of symptomatic bleed and poor functional outcome.”

Dr. Bhagat and colleagues conducted a retrospective analysis of 35 patients with diabetes and 35 without diabetes who underwent mechanical thrombectomy at the University of Louisville between 2014 and 2018. Patients with diabetes were older (67.7 vs 55.5 years) and more patients with diabetes had hypertension (33 vs 25).

No significant difference was seen in successful revascularisation between patients with and without diabetes (92% vs 84%; P = .29). Good outcomes were achieved by 4 patients with diabetes and by 13 patients without diabetes (10.5% vs 34.2%; P = .013). Mortality was higher in the patients with diabetes (12 vs 4; P = .024).

Advanced age was not linked to increased modified rankin scale (mRS) on discharge in patients with diabetes, but elevated National Institutes of Health Stroke Scale (NIHSS) was linked to increased mRS in patients with diabetes (P = .01).

At discharge, median mRS in right- versus left-sided stroke among patients with diabetes was 4 (interquartile range [IQR], 3-5) versus 5 (IQR, 4-6) in those without diabetes (P = .11).

“Usually, a left-sided stroke means a poor outcome,” said Dr. Bhagat. “What we saw was that it did not matter if it was the left or the right side among patients with diabetes. Regardless, the outcome was poor.”

He said that a larger retrospective study is planned to confirm the current findings.

[Presentation title: Comparison of Functional Outcome After Outcome After Mechanical Thrombectomy Between Diabetic and Non-Diabetic Patients. Abstract 304]