Journal Article

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

Bruno, Askiel, Williams, Alana, Southerland, Andrew M., Visweswaran, Anita, Ulep, Robin, Hannawi, Yousef, Gunter, Sonya, Kumar, Kevin K., Wintermark, Max, Conaway, Mark R., Johnston, Karen C., Patel, Vishal N., Hirsch, Karen, Giurgiutiu, Dan-Victor, Shutter, Lori, Joyner, David, Faber, James, Arteaga, Daniel F., Haughey, Heather M., Aziz, Yasmin, Sharashidze, Vera, Williams, Kori

2022

Overview

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.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Analysis / Angiography / Blood Glucose / Care and treatment / Cerebral blood flow / Cerebral infarction / Cerebral ischemia / Clinical Trials as Topic / Collateral Circulation / Complications and side effects / Computed tomography / CT imaging / Diabetes / Diagnosis / Enrollments / Glucose / Hemodynamics / Humans / Hyperglycemia / Hyperglycemia - drug therapy / Hypotheses / Insulin / Intracranial collaterals / Ischemia / Ischemic Stroke / Medicine / Medicine & Public Health / Meninges / Methods / Neurochemistry / Neurology / Neurosurgery / Outcome / Patients / Research Article / Risk factors / Statistical significance / Stroke / Stroke (Disease) / t-Plasminogen activator / Thrombectomy - methods / Thrombolysis / Thrombolytic drugs / Tissue plasminogen activator / Tissue Plasminogen Activator - therapeutic use / Treatment Outcome