Jan Borggrefe1, Berit Glück2, Volker Maus3, Özgür Onur4, Nuran Abdullayev2, Utako Barnikol5, Christoph Kabbasch2, Gereon Rudolf Fink4, Anastasios Mpotsaris6. 1. Department of Diagnostic and Interventional Radiology and Neuroradiology, Cologne, Germany. Electronic address: Jan.Borggrefe@uk-koeln.de. 2. Department of Diagnostic and Interventional Radiology and Neuroradiology, Cologne, Germany. 3. Department of Neuroradiology, University Hospital of Göttingen, Göttingen, Germany. 4. Department of Neurology, University Hospital of Cologne, Cologne, Germany. 5. Medical Ethics, University Hospital of Cologne, Cologne, Germany. 6. Department of of Neuroradiology, University Hospital of Aachen, Aachen, Germany.
Abstract
BACKGROUND: Among patients with acute ischemic stroke treated with mechanical thrombectomy (MT), patients with diabetes (DP) show a poorer outcome compared with patients without diabetes (NDP). This study aims to provide a comprehensive analysis of factors associated with unfavorable outcome in DP receiving MT for stroke of the anterior circulation. METHODS: This study included 317 of 498 consecutive patients who received interventional treatment for acute ischemic stroke in the terminal internal carotid artery and/or middle cerebral artery, including 46 DP. The study data included pre- and posttreatment stroke computed tomography, including perfusion data, collateral status, treatment data including treatment times, pre-existing cardiovascular risk factors, cerebrovascular events, comorbidities, laboratory parameters, and medication. Neurologic status was assessed at baseline (National Institute of Health Stroke Scale [NIHSS]/modified Rankin Scale [mRS]) and after 90 days (mRS 90). RESULTS: Compared with NDP, DP showed a significantly poorer outcome (mRS90 >2) (P < 0.05). Collateralization and infarct core size did not differ between groups, whereas the penumbra was significantly smaller in DP than in NDP (P < 0.05). The poorer mRS90 outcome (mRS90 > 2) in DP was associated with poor collaterals (P = 0.01) and hyperglycemia on admission (P < 0.05). Shorter time to reperfusion was associated with favorable mRS90 in the NDP (P < 0.001) but not the DP (P = 0.49) group. In univariate logistic regression, the following parameters were significantly associated with mRS90: diabetes, hyperglycemia at admission, time to reperfusion, and the NIHSS score (P < 0.05 each). In multivariate analyses and partition regression models of all variables, DP with admission hyperglycemia (≥132 mg/dL) and older age (≥66 years) showed a particularly poor outcome. CONCLUSIONS: The main factors for an unfavorable outcome of DP after MT are admission hyperglycemia, age, and NIHSS score.
BACKGROUND: Among patients with acute ischemic stroke treated with mechanical thrombectomy (MT), patients with diabetes (DP) show a poorer outcome compared with patients without diabetes (NDP). This study aims to provide a comprehensive analysis of factors associated with unfavorable outcome in DP receiving MT for stroke of the anterior circulation. METHODS: This study included 317 of 498 consecutive patients who received interventional treatment for acute ischemic stroke in the terminal internal carotid artery and/or middle cerebral artery, including 46 DP. The study data included pre- and posttreatment stroke computed tomography, including perfusion data, collateral status, treatment data including treatment times, pre-existing cardiovascular risk factors, cerebrovascular events, comorbidities, laboratory parameters, and medication. Neurologic status was assessed at baseline (National Institute of Health Stroke Scale [NIHSS]/modified Rankin Scale [mRS]) and after 90 days (mRS 90). RESULTS: Compared with NDP, DP showed a significantly poorer outcome (mRS90 >2) (P < 0.05). Collateralization and infarct core size did not differ between groups, whereas the penumbra was significantly smaller in DP than in NDP (P < 0.05). The poorer mRS90 outcome (mRS90 > 2) in DP was associated with poor collaterals (P = 0.01) and hyperglycemia on admission (P < 0.05). Shorter time to reperfusion was associated with favorable mRS90 in the NDP (P < 0.001) but not the DP (P = 0.49) group. In univariate logistic regression, the following parameters were significantly associated with mRS90: diabetes, hyperglycemia at admission, time to reperfusion, and the NIHSS score (P < 0.05 each). In multivariate analyses and partition regression models of all variables, DP with admission hyperglycemia (≥132 mg/dL) and older age (≥66 years) showed a particularly poor outcome. CONCLUSIONS: The main factors for an unfavorable outcome of DP after MT are admission hyperglycemia, age, and NIHSS score.
Authors: Emilia Scheidecker; Benjamin Pereira-Zimmermann; Arne Potreck; Dominik F Vollherbst; Markus A Möhlenbruch; Christoph Gumbinger; Martin Bendszus; Christian Herweh; Fatih Seker Journal: Neuroradiology Date: 2021-12-09 Impact factor: 2.995
Authors: Kotryna Genceviciute; Martina B Göldlin; Christoph C Kurmann; Adnan Mujanovic; Thomas R Meinel; Johannes Kaesmacher; David J Seiffge; Simon Jung; Pasquale Mordasini; Urs Fischer; Jan Gralla; Hakan Sarikaya; Barbara Goeggel Simonetti; Kateryna Antonenko; Roza M Umarova; Lia Bally; Marcel Arnold; Mirjam R Heldner Journal: Eur J Neurol Date: 2022-07-01 Impact factor: 6.288