Association of Glycated Hemoglobin (HbA1c) with Functional Outcomes After Endovascular Thrombectomy for Acute Ischemic Stroke

Huaishun Wang,1,* Dan Tao,2,* Junhao Du,1 Jie Chen,2 Guodong Xiao1 1Second Affiliated Hospital of Soochow University, Suzhou, 215004, People’s Republic of China; 2Fourth Affiliated Hospital of Soochow University, Suzhou, 215004, People’s Republic of China*These authors contributed equally to this workCorrespondence: Guodong Xiao, Email yarrowshaw@hotmail.com Jie Chen, Email chenjiesuzhou@126.comBackground: The impact of chronic glycemic control, measured by glycated hemoglobin (HbA1c), on functional outcomes after endovascular thrombectomy (EVT) for acute large vessel occlusion (LVO) stroke remains to be fully elucidated.Methods: We conducted a retrospective cohort study of 443 consecutive patients with anterior circulation LVO stroke who underwent EVT. Patients were categorized by HbA1c levels: low (< 6.0%), medium (6.0– 7.0%), and high (> 7.0%). The primary outcome was a poor functional outcome (modified Rankin Scale score 3– 6) at 3 months. The secondary outcome was symptomatic intracranial hemorrhage (sICH).Results: Among the 443 patients, 229 (51.7%) had a poor functional outcome. Higher HbA1c levels were significantly associated with an increased risk of poor outcome after adjustment for confounders (P for trend = 0.013). When analyzed as a continuous variable, HbA1c showed a nonlinear relationship with poor outcome; risk increased with rising HbA1c until a threshold of 7.1%, after which the rate of increase attenuated. No significant association was found between HbA1c and sICH. Subgroup analysis revealed a significant interaction between HbA1c and thrombolysis (t-PA) administration (P for interaction = 0.042), indicating that the association between high HbA1c and poor outcome was more pronounced in patients who received t-PA.Conclusion: Elevated HbA1c is independently associated with an increased risk of poor 3-month functional outcomes after EVT, with a risk threshold observed at 7.1%. These findings underscore the importance of long-term glycemic control in stroke management.Keywords: HbA1c, endovascular thrombectomy, functional outcome, ischemic stroke, glycemic control