Bin Luo,1,2,* Yi Xiang,3,* Yueming Pan,4,* Fanlei Meng,5 Juanjuan Zhang,6 Zhiguang Liu,7 Peixian Lin,8 Long Zhang,9 Yubo Wang,2 Hecheng Ren,2 Lin Ma,2 Ying Huang2 

1Academy of Medical Engineering and Translational Medicine, Tianjin University, Tianjin, People’s Republic of China; 2Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin, People’s Republic of China; 3Department of Neurosurgery, Xianyang Central Hospital, Xianyang, People’s Republic of China; 4Department of Emergency, Rizhao People’s Hospital, Rizhao, People’s Republic of China; 5Department of Neurosurgery, Tianjin Medical University Second Hospital, Tianjin, People’s Republic of China; 6Department of Geriatrics, Leling People’s Hospital, Leling, People’s Republic of China; 7Department of Neurology, Xuzhou Central Hospital, Xuzhou, People’s Republic of China; 8Department of Encephalopathy, Anxi County Hospital of Traditional Chinese Medicine, Anxi, People’s Republic of China; 9Department of Neurosurgery, the First Hospital of Qinhuangdao, Qinhuangdao, People’s Republic of China

*These authors contributed equally to this work

Correspondence: Lin Ma, Email malin19780922@163.com Ying Huang, Email yinghuang_hhyy@163.com

Purpose: 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.
Materials and Methods: 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.
Results: 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.
Conclusion: 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.

Keywords: acute large vessel occlusion, blood glucose, propensity matching, mechanical thrombectomy, prognosis