Fasting Blood Glucose on Prognosis After Acute Large Vessel Occlusion Reperfusion- A Multi-Center Study Based on Propensity Score Matching

To determine the impact of 24-hour post-reperfusion glycemic control on 90-day functional outcomes in acute large vessel occlusion (ALVO) patients after successful recanalization. This multi-center retrospective study analyzed 2056 ALVO patients (male: 1488; female: 568) from three cerebrovascular centers achieving successful reperfusion via mechanical thrombectomy with/without bridging thrombolysis. Using 1:1 propensity score matching (covariates: gender, age, Diabetes mellitus, hypertension, hyperlipidemia, cardiac disease, smoking status, glucose measurement timing, baseline NIHSS, and preoperative mRS), 194 matched pairs (mean age 63[IQR 55-71] years; male: 278) were stratified by 90-day modified Rankin Scale (mRS) outcomes into favorable (mRS 0-2) and poor prognosis (mRS 3-6) cohorts. The poor prognosis cohort demonstrated significantly elevated mean fasting blood glucose (MFBG) levels (7.22 mmol/L [6.66-8.50] vs 6.86 mmol/L [6.28-7.58], P<0.001). Multivariable logistic regression adjusted for sex, age, vascular risk profile, and baseline NIHSS (adjusted OR=0.819, 95% CI 0.714-0.940, P=0.004) confirmed MFBG elevation as an independent risk factor for unfavorable outcomes. Sustained hyperglycemia during the initial 24-hour post-recanalization period independently predicts impaired 90-day functional recovery in ALVO patients. These findings highlight the imperative for standardized glucose monitoring protocols during the hyperacute post-thrombectomy phase, while optimal glycemic targets (<7.0 mmol/L vs individualized thresholds) and therapeutic windows for neuroprotection warrant validation through prospective multicenter RCTs.