Evolution of glucose levels in patients with anterior circulation acute ischemic stroke treated with endovascular therapy using continuous glucose monitoring

Introduction: Hyperglycemia is common in acute ischemic stroke, and associated with larger infarct volume and unfavorable functional outcome. To identify a subgroup that may benefit from glucose lowering in future studies, we assessed the evolution of glucose levels in the first 24 hrs after admission using continuous glucose monitoring in patients with anterior circulation large vessel occlusion ischemic stroke who underwent endovascular therapy (EVT). Methods: In a prospective two center cohort study, consecutive patients with anterior circulation ischemic stroke, who were eligible for EVT within 24 hrs of symptom onset, were enrolled. Glucose monitoring was performed using a Freestyle Libre Flash 2 device during 24 hrs. We analysed median glucose on admission, time ratio of glucose > 7.8 mmol/L (7.8 time-ratio) and coefficient of variation (% CV), including relations with predefined patient characteristics and outcomes. Results: One hundred and two patients were included in the analyses, with a median stroke-onset-to-measurement-time of 4 hrs. Median glucose on admission was 7.0 mmol/L (IQR 6.0-8.4 mmol/L). Overall, 7.8 time-ratio and % CV were 13% and 4% respectively. In patients who were normoglycemic or hyperglycemic on admission, the glucose variability was small with % CV of 6% and 4% respectively. Hyperglycemia on admission, high HbA1C, successful recanalization, older age, and high NIHSS scores were associated with higher 7.8 time-ratio. Conclusion: Glucose monitoring and studies on effectiveness of glucose lowering may be especially useful in EVT patients with hyperglycemia on admission, high HbA1C, successful recanalization, older age and high initial NIHSS scores.