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J Stroke Cerebrovasc Dis. 2017 Nov;26(11):2615-2621. doi: 10.1016/j.jstrokecerebrovasdis.2017.06.025. Epub 2017 Aug 4.

Recently Uncontrolled Glycemia in Diabetic Patients Is Associated with the Severity of Intracranial Atherosclerosis.

Author information

1
Departments of Neurology, Soonchunhyang University School of Medicine, Seoul, Republic of Korea.
2
Departments of Radiology, Soonchunhyang University School of Medicine, Seoul, Republic of Korea.
3
Departments of Neurology, Soonchunhyang University School of Medicine, Seoul, Republic of Korea. Electronic address: kblee@schmc.ac.kr.

Abstract

BACKGROUND AND PURPOSE:

Diabetes mellitus is a specific risk factor for intracranial atherosclerosis (ICAS) regardless of race. However, it is largely unknown whether poor glycemic control is associated with the severity of ICAS in diabetic patients.

METHODS:

We selected diabetic patients with acute ischemic stroke who were prospectively registered between March 2005 and December 2015. The patients who had a high-risk source of cardiogenic embolism were excluded. ICAS was graded from 0 to 3 by the number of significant (≥50%) stenoses on intracranial magnetic resonance angiography, and was divided into 4 types: unilateral anterior, bilateral anterior, posterior, and anterior plus posterior. Ordinal and multinomial regression tests were applied for the factors influencing the number and types of ICAS.

RESULTS:

A total of 774 patients with noncardioembolic acute ischemic stroke with diabetes were enrolled. The multiplicity of ICAS was independently associated with age (odds ratio [OR], 1.035 per 1 year, 1.018-1.052; P < .001), hypertension (OR, 1.992, 1.336-2.965; P = .001), and glycated hemoglobin (HbA1c; OR, 1.207 per 1%, 1.089-1.338; P < .001) in the ordinal regression model. In multinomial regression, bilateral anterior stenosis tended to be correlated with age (OR, 1.042, 1.008-1.077; P = .016) and HbA1c (OR, 1.201 per 1%, .991-1.520; P = .057). Both anterior and posterior stenoses were significantly associated with age (OR, 1.056, 1.029-1.084; P < .001), hypertension (OR, 2.584, 1.404-4.762; P = .002), and HbA1c (OR, 1.272, 1.070-1.511; P = .006).

CONCLUSIONS:

Age, concomitant hypertension, and HbA1c were factors associated with multiple intracranial stenoses. Further study is warranted to elucidate whether poor glycemic control facilitates ICAS in diabetic patients.

KEYWORDS:

Diabetes; angiography; glycated hemoglobin; intracranial atherosclerosis

[Indexed for MEDLINE]

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