Glycosylated Hemoglobin A1c Predicts Intracerebral Hemorrhage with Acute Ischemic Stroke Post-Mechanical Thrombectomy

Chenghe Sun; Chuanjie Wu; Wenbo Zhao; Longfei Wu; Di Wu; Weili Li; Dongmei Wei; Qingfeng Ma; Hong Chen; Xunming Ji

doi:10.1016/j.jstrokecerebrovasdis.2020.105008

Glycosylated Hemoglobin A1c Predicts Intracerebral Hemorrhage with Acute Ischemic Stroke Post-Mechanical Thrombectomy

J Stroke Cerebrovasc Dis. 2020 Sep;29(9):105008. doi: 10.1016/j.jstrokecerebrovasdis.2020.105008. Epub 2020 Jun 15.

Authors

Chenghe Sun¹, Chuanjie Wu², Wenbo Zhao², Longfei Wu², Di Wu³, Weili Li², Dongmei Wei⁴, Qingfeng Ma², Hong Chen⁴, Xunming Ji⁵

Affiliations

¹ Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China; Affiliated Qiqihar Hospital, Southern Medical University, Qiqihar, China.
² Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.
³ China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China.
⁴ The First Hospital of Qiqihar, Qiqihar, China; Affiliated Qiqihar Hospital, Southern Medical University, Qiqihar, China.
⁵ Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China. Electronic address: [email protected].

PMID: 32807423
DOI: 10.1016/j.jstrokecerebrovasdis.2020.105008

Abstract

Background: Intracerebral hemorrhage, including symptomatic intracerebral hemorrhage, is a serious post-mechanical thrombectomy complication in patients with acute ischemic stroke. We aimed to determine whether glycosylated hemoglobin A1c parameters could predict intracerebral hemorrhage in this patient population.

Methods: We enrolled patients with acute occlusion of the internal carotid artery or proximal middle cerebral artery and who had undergone mechanical thrombectomy. According to the glycosylated hemoglobin A1c level (%) assessed during the hospital stay, the patients were divided into two groups: > 6.5% and ≤ 6.5%. Intracerebral hemorrhage was evaluated and classified based on cranial computed tomography scans obtained within 24-48 h or when neurological conditions worsened. We assessed the outcome at the end of 90 days using the modified Rankin Scale scores.

Results: Among 202 patients, 86 (42.6%) suffered intracerebral hemorrhage, while 25 (12.4%) had symptomatic intracerebral hemorrhage; 35.6% of the patients had a favorable outcome (modified Rankin Scale scores 0-2). Multivariable analysis demonstrated an association of glycosylated hemoglobin A1c > 6.5% with intracerebral hemorrhage. Furthermore, glycosylated hemoglobin A1c > 6.5% was independently associated with symptomatic intracerebral hemorrhage (OR, 2.136; 95% CI, 1.279-3.567; P = 0.004). In addition, glycosylated hemoglobin A1c > 6.5% was significantly associated with increased mortality (OR, 1.511; 95% CI, 1.042-2.191; P = 0.029) and negatively associated with favorable outcome (OR, 0.480; 95% CI, 0.296-0.781; P = 0.003) at 90 days.

Conclusions: Glycosylated hemoglobin A1c is an independent predictor of intracerebral hemorrhage (specifically, symptomatic intracerebral hemorrhage) in patients with acute ischemic stroke treated with mechanical thrombectomy. Further studies are needed to validate these findings.

Keywords: Acute ischemic stroke; Glycosylated hemoglobin A1c; Intracerebral hemorrhage; Mechanical thrombectomy.

MeSH terms

Aged
Biomarkers / blood
Carotid Stenosis / blood
Carotid Stenosis / diagnostic imaging
Carotid Stenosis / physiopathology
Carotid Stenosis / therapy*
Cerebral Hemorrhage / blood
Cerebral Hemorrhage / diagnostic imaging
Cerebral Hemorrhage / etiology*
Female
Glycated Hemoglobin / metabolism*
Humans
Infarction, Middle Cerebral Artery / blood
Infarction, Middle Cerebral Artery / diagnostic imaging
Infarction, Middle Cerebral Artery / physiopathology
Infarction, Middle Cerebral Artery / therapy*
Male
Middle Aged
Registries
Risk Assessment
Risk Factors
Thrombectomy / adverse effects*
Time Factors
Treatment Outcome

Substances

Biomarkers
Glycated Hemoglobin A
hemoglobin A1c protein, human