Collateral status, hyperglycemia, and functional outcome after acute ischemic stroke

• Type of Material: Article
• Authors: Daniel F Arteaga, St Thomas Rutherford Hosp; Robin Ulep, Stanford University; Kevin K Kumar, Stanford University; Andrew M Southerland, University of Virginia; Mark R Conaway, University of Virginia; James Faber, University of North Carolina; Max Wintermark, Stanford University; David Joyner, University of Virginia; Vera Sharashidze, Emory University; Karen Hirsch, Stanford University; Dan-Victor Giurgiutiu, Augusta University; Yousef Hannawi, Ohio State University; Yasmin Aziz, University of Pittsburgh; Lori Shutter, University of Pittsburgh; Anita Visweswaran, Stanford University; Alana Williams, Emory University; Kori Williams, Augusta University; Sonya Gunter, University of Virginia; Heather M Haughey, University of Virginia; Askiel Bruno, Augusta University; Karen C Johnston, University of Virginia; Vishal Patel, Emory University
• Language: English
• Date: 2022-11-04
• Publisher: BMC
• Publication Version: Final Published Version
• Copyright Statement: © This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply 2022
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1186/s12883-022-02943-4
• Title of Journal or Parent Work: BMC NEUROLOGY
• Volume: 22
• Issue: 1
• Start Page: 408
• End Page: 408
• Grant/Funding Information: This work was funded by NIH-NINDS U01 NS069498, NIH-NINDS U01 NS056975, and NIH-NINDS U01 NS059041.
• Keywords: Intracranial collaterals; Outcome; Life Sciences & Biomedicine; Neurosciences & Neurology; Ischemic stroke; Diabetes; Science & Technology; Angiography; Hyperglycemia; Clinical Neurology
• Research Categories: Health Sciences, Radiology; Biology, Cell

Abstract

Background: Mixed data exist regarding the association between hyperglycemia and functional outcome after acute ischemic stroke when accounting for the impact of leptomeningeal collateral flow. We sought to determine whether collateral status modifies the association between treatment group and functional outcome in a subset of patients with large vessel occlusion enrolled in the Stroke Hyperglycemia Insulin Network Effort (SHINE) trial. Methods: In this post-hoc analysis, we analyzed patients enrolled into the SHINE trial with anterior circulation large vessel occlusion who underwent imaging with CT angiography prior to glucose control treatment group assignment. The primary analysis assessed the degree to which collateral status modified the effect between treatment group and functional outcome as defined by the 90-day modified Rankin Scale score. Logistic regression was used to model the data, with adjustments made for thrombectomy status, age, post-perfusion thrombolysis in cerebral infarction (TICI) score, tissue plasminogen activator (tPA) use, and baseline National Institutes of Health Stroke Scale (NIHSS) score. Five SHINE trial centers contributed data for this analysis. Statistical significance was defined as a p-value < 0.05. Results: Among the 1151 patients in the SHINE trial, 57 with angiographic data were included in this sub-analysis, of whom 19 had poor collaterals and 38 had good collaterals. While collateral status had no effect (p = 0.855) on the association between glucose control treatment group and functional outcome, patients with good collaterals were more likely to have a favorable functional outcome (p = 0.001, OR 5.02; 95% CI 1.37–16.0). Conclusions: In a post-hoc analysis using a subset of patients with angiographic data enrolled in the SHINE trial, collateral status did not modify the association between glucose control treatment group and functional outcome. However, consistent with prior studies, there was a significant association between good collateral status and favorable outcome in patients with large vessel occlusion stroke. Trial registration: ClinicalTrials.gov Identifier is NCT01369069. Registration date is June 8, 2011.