Does Diabetes Mellitus Influence the Association Between Stress Hyperglycemia and Leptomeningeal Collateral Circulation in Acute Ischemic Stroke Patients?
Emanuele Camerucci1, Tuqa Asedi2, Chelsey Schartz2, Dina Al-Nuaimi5, Hussein Alsadi3, Mohammed Qussay Ali Al-Sabbagh4, Prasanna Venkatesan Eswaradass6
1Department of neurology, Kansas University Medical Center, 2University of Kansas Medical Center, 3Department of radiology, 4Department of neurology, University of Kansas Medical Center, 5University Of Jordan school of medicine, 6Department of neurology, University of Kansas Health System
Objective:
To determine if stress hyperglycemia (SHG) has a differential impact on leptomeningeal collateral (LMC) circulation in acute ischemic stroke (AIS) based on the presence or absence of diabetes mellitus (DM)
Background:
SHG is associated with poor LMC in AIS and subsequently, reperfusion therapy outcomes. It is unclear if the impact of SHG on LMCs varies based on the DM status.
Design/Methods:
In this retrospective single-center study, we reviewed patients admitted with AIS, who either had internal carotid artery or middle cerebral artery occlusion, with fasting glucose and CTA obtained within 24 hours of admission. SHG calculated using the formula: admission blood glucose/[(28.7 × HbA1c%) – 46.7]. CTA collaterals were classified using the Regenhardt et al. system. We further reclassified into “Good” (included symmetric and intermediate) and “Poor”(Malignant). Wilcoxon Rank Sum Test was used to compare SHR in individuals with good and poor collaterals
Results:
A total of 266 patients were included, 54.5% (n=145) were males, 45.5% (n=121) were females. Among them, 20% (n=53) had a history of DM. CTA collateral score was deemed malignant in 24.5% (n=65), and symmetric in 35% (n=93). Overall, SHR showed lower values in individuals with good collateral, compared to poor collateral status (P=0.02). When analyzing DM and non-DM patients separately, we found that non-DM patients with good collaterals had a significantly lower SHR (0.9±0.2 vs 1.2±0.2, p < 0.01). In contrast, among DM patients, SHR scores were similar between those with good and poor collaterals (1±0.4 vs 1.1±0.2, p = 0.07)
Conclusions:
SHG at admission is a useful predictor of poor collaterals. SHG is more strongly associated with poor collaterals in non-DM patients compared to those with DM in our study which contrasts with some prior studies. Additional larger population-based studies are necessary to validate this association.
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