Abstract Background and aims Hyperglycemia after mechanical thrombectomy (MT) is a known poor prognostic factor, but the specific impact of mild hyperglycemia remains unclear. This study evaluated how the severity and burden of hyperglycemia during the first week after admission influence functional outcomes in patients undergoing MT. Methods We retrospectively analyzed 351 MT cases between January 2022 and December 2024. Exclusion criteria included pre-stroke mRS ≥3, TICI grade ≤2a, and missing glucose data. Patients were classified into three groups based on the maximum glucose levels during the first week: Normal (N: 180 mg/dL), Mild Hyperglycemia (MH: 180–249 mg/dL), and Severe Hyperglycemia (SH: ≥250 mg/dL). In the MH, the hyperglycemia ratio (episodes ≥180 mg/dL / total measurements) was also assessed. The primary endpoint was mRS shift analysis at 90 days. Results A total of 221 patients were included (N=138, MH=62, SH=21; median age 76; 61.5% male). Baseline characteristics were comparable among groups. Shift analysis showed that both MH and SH were independently associated with worse functional outcomes compared with N (MH: aOR 2.19, 95%CI 1.28-3.77; SH: aOR 2.70, 95%CI 1.20-6.08). Within the MH, each 5% increase in the frequency of hyperglycemia (≥180 mg/dL) was significantly associated with a shift toward poorer mRS (aOR1.09, 95%CI 1.01-1.18, p=0.037). Conclusions Even mild hyperglycemia negatively impacts functional outcomes after MT. A greater burden of hyperglycemic exposure, even within the mild range, is significantly associated with poorer prognosis, highlighting the importance of strict glycemic monitoring and management in the early post-thrombectomy period. Conflict of interest Rimi Hirota, Kota Maekawa, Nobuyuki Ohara, Michi Kawamoto, Tsuyoshi Ohta : nothing to disclose
Hirota et al. (2026) studied this question.