Diabetes is an Independent Growth Factor of Ischemic Stroke During Reperfusion Phase Leading to Poor Clinical Outcome |
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| Institution: | 1. Stroke Unit, University Hospital of Marseille (AP-HM), Marseille, France;2. Radiology Unit, Teaching Military Hospital, Toulon;3. Neuroradiology Department, University Hospital of Marseille (AP-HM), Marseille, France;4. Center for Cardiovascular and Nutrition Research (C2VN), Aix Marseille University, Marseille, France;1. Department of Rehabilitation Medicine, St. Marianna University School of Medicine, Yokohama City Seibu Hospital, 1197-1 Yasashicho, Asahi-ku, Yokohama, Kanagawa 241-0811, Japan;2. Faculty of Medical Science, Shonan University of Medical Sciences, 16-48, Kamishinano, Totsuka-ku, Yokohama, Kanagawa 244-0806, Japan;3. Department of Rehabilitation Medicine, Sakuragaoka Central Hospital, 1-7-1 Fukuda, Yamato, Kanagawa 242-0024, Japan;4. Department of Neurosurgery, St. Marianna University School of Medicine Yokohama City Seibu Hospital, 1197-1 Yasashicho, Asahi-ku, Yokohama, Kanagawa 241-0811, Japan;1. Department of Health and Environmental Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan;2. Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan;3. Department of Artificial Intelligence in Healthcare and Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan;4. Social Health Medicine Welfare Laboratory, Public Interest Incorporated Association Kyoto Hokenkai, Kyoto, Japan;1. Intensive Care Unit of the Affiliated Huai''an Hospital of Xuzhou Medical University, Huai''an 223001, Jiangsu, China;2. Laboratory of Emergency Medicine, Second Clinical Medical College of Xuzhou Medical University, Xuzhou, 221004, China;3. Emergency Medicine Department of the Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221002, China;1. Department of Neurology, Mie University Graduate School of Medicine, 2-chome-174 Edobashi, Tsu, Mie 514-0001, Japan;2. Division of Rehabilitation, Mie University Hospital, Tsu, Mie, Japan;3. Department of Emergency and Disaster Medicine, Mie University Graduate School of Medicine, Japan;4. Department of Rehabilitation Medicine, Mie University Graduate School of Medicine, Tsu, Mie, Japan;5. Department of Neurosurgery, Mie University Graduate School of Medicine, Japan;1. Department of Neurology, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shimmachi, Suita, Osaka 564-8565, Japan;2. Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan;1. Service d''Anesthésie-Réanimation, Hôpital Laënnec, Centre Hospitalier Universitaire, Nantes F-44093, France;2. CHU de Nantes, Inserm CIC 1413, Pôle Hospitalo-Universitaire 11: Santé Publique, Clinique des Données, Nantes, France;3. Department of Diagnostic and Therapeutic Neuroradiology, University Hospital of Nantes, Nantes F-44093, France;4. Institut du Thorax, Institut National de la Santé et de la Recherche Médicale (INSERM), Centre National de la Recherche Scientifique (CNRS), Université de Nantes, Nantes F-44093, France |
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| Abstract: | ObjectivesDespite the success of recanalization by bridging therapy, about half of treated stroke patients remain disabled. While numerous reports propose clinical predictors of stroke clinical outcome in this context, we originally aimed to study pre-therapeutic factors influencing infarct growth (IG) and poor clinical outcome in strokes due to large vessel occlusion (LVO) successfully recanalized.Materials and methodsWe enrolled 87 consecutive successfully recanalized patients (mTICI: 2b/2c/3) by mechanical thrombectomy (±rt-PA) after stroke due to middle cerebral artery (M1) occlusion within 6 h according to AHA guidelines. IG was defined by subtracting the initial DWI volume to the final 24 h-TDM volume. Statistical associations between poor clinical outcome (mRS≥2), IG and pertinent clinico-radiological variables, were measured using logistic and linear regression models.ResultsAmong 87 enrolled patients (Age(y): 68.4 ± 17.5; NIHSS: 16.0 ± 5.4), 42/87 (48,28%) patients had a mRS ≥ 2 at 3 months. Diabetic history (OR: 3.70 CI95%1.03;14.29] and initial NIHSS (/1 point: OR: 1.16 CI95%1.05;1.27]) were independently associated with poor outcome. IG was significantly higher in stroke patients with poor outcome (+7.57 ± 4.52 vs ?7.81 ± 1.67; p = 0.0024). Initial volumes were not significantly different (mRS≥2: 16.18 ± 2.67; mRS0–1]: 14.70 ± 2.30; p = 0.6771). Explanatory variables of IG in linear regression were diabetic history (β: 21.26 CI95%5.43; 37.09]) and NIHSS (β: 0.83 CI95%0.02; 1.64]). IG was higher in diabetic stroke patients (23.54 ± 1.43 vs ?6.20 ± 9.36; p = 0.0061).ConclusionsWe conclude that diabetes leads to continued IG after complete recanalization, conditioning clinical outcome in LVO strokes successfully recanalized by bridging therapy. We suggest that poor tissular reperfusion by diabetic microangiopathy could explain this result. |
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| Keywords: | IG"} {"#name":"keyword" "$":{"id":"pc_q9don0jIGS"} "$$":[{"#name":"text" "_":"Infarct Growth LVO"} {"#name":"keyword" "$":{"id":"pc_DJK3qOGrL8"} "$$":[{"#name":"text" "_":"Large Vessel Occlusion DWI"} {"#name":"keyword" "$":{"id":"pc_4lh9tLmYCD"} "$$":[{"#name":"text" "_":"Diffusion-Weighted Imaging |
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