Collateral status, hyperglycemia, and functional outcome after acute ischemic stroke
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...
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BMC
2022-11-01
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| Series: | BMC Neurology |
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| Online Access: | https://doi.org/10.1186/s12883-022-02943-4 |
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| author | Daniel F. Arteaga Robin Ulep Kevin K. Kumar Andrew M. Southerland Mark R. Conaway James Faber Max Wintermark David Joyner Vera Sharashidze Karen Hirsch Dan-Victor Giurgiutiu Yousef Hannawi Yasmin Aziz Lori Shutter Anita Visweswaran Alana Williams Kori Williams Sonya Gunter Heather M. Haughey Askiel Bruno Karen C. Johnston Vishal N. Patel SHINE Trial Investigators |
| author_facet | Daniel F. Arteaga Robin Ulep Kevin K. Kumar Andrew M. Southerland Mark R. Conaway James Faber Max Wintermark David Joyner Vera Sharashidze Karen Hirsch Dan-Victor Giurgiutiu Yousef Hannawi Yasmin Aziz Lori Shutter Anita Visweswaran Alana Williams Kori Williams Sonya Gunter Heather M. Haughey Askiel Bruno Karen C. Johnston Vishal N. Patel SHINE Trial Investigators |
| author_sort | Daniel F. Arteaga |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-04-13T15:31:25Z |
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| institution | Directory Open Access Journal |
| issn | 1471-2377 |
| language | English |
| last_indexed | 2024-04-13T15:31:25Z |
| publishDate | 2022-11-01 |
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| spelling | doaj.art-c42cb282b8eb4afba90d13bb3b31f3b62022-12-22T02:41:23ZengBMCBMC Neurology1471-23772022-11-012211510.1186/s12883-022-02943-4Collateral status, hyperglycemia, and functional outcome after acute ischemic strokeDaniel F. Arteaga0Robin Ulep1Kevin K. Kumar2Andrew M. Southerland3Mark R. Conaway4James Faber5Max Wintermark6David Joyner7Vera Sharashidze8Karen Hirsch9Dan-Victor Giurgiutiu10Yousef Hannawi11Yasmin Aziz12Lori Shutter13Anita Visweswaran14Alana Williams15Kori Williams16Sonya Gunter17Heather M. Haughey18Askiel Bruno19Karen C. Johnston20Vishal N. Patel21SHINE Trial InvestigatorsDepartment Neurology, St Thomas Rutherford HospitalDepartment of Neurology, Stanford UniversityDepartment of Neurosurgery, Stanford UniversityDepartment of Neurology, University of VirginiaDepartment of Statistics, University of VirginiaDepartment of Cell Biology and Physiology, University of North CarolinaDepartment of Radiology, Stanford UniversityDepartment of Radiology, University of VirginiaDepartment of Neurology, Emory UniversityDepartment of Neurology, Stanford UniversityDepartment of Neurology, Medical College of Georgia at Augusta UniversityDepartment of Neurology, The Ohio State UniversityDepartment of Neurology, University of PittsburghDepartment of Critical Care Medicine, University of PittsburghDepartment of Neurology, Stanford UniversityDepartment of Neurology, Emory UniversityDepartment of Neurology, Medical College of Georgia at Augusta UniversityDepartment of Neurology, University of VirginiaDepartment of Neurology, University of VirginiaDepartment of Neurology, Medical College of Georgia at Augusta UniversityDepartment of Neurology, University of VirginiaDepartment of Neurology, Emory UniversityAbstract 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.https://doi.org/10.1186/s12883-022-02943-4Intracranial collateralsHyperglycemiaDiabetesAngiographyIschemic strokeOutcome |
| spellingShingle | Daniel F. Arteaga Robin Ulep Kevin K. Kumar Andrew M. Southerland Mark R. Conaway James Faber Max Wintermark David Joyner Vera Sharashidze Karen Hirsch Dan-Victor Giurgiutiu Yousef Hannawi Yasmin Aziz Lori Shutter Anita Visweswaran Alana Williams Kori Williams Sonya Gunter Heather M. Haughey Askiel Bruno Karen C. Johnston Vishal N. Patel SHINE Trial Investigators Collateral status, hyperglycemia, and functional outcome after acute ischemic stroke BMC Neurology Intracranial collaterals Hyperglycemia Diabetes Angiography Ischemic stroke Outcome |
| title | Collateral status, hyperglycemia, and functional outcome after acute ischemic stroke |
| title_full | Collateral status, hyperglycemia, and functional outcome after acute ischemic stroke |
| title_fullStr | Collateral status, hyperglycemia, and functional outcome after acute ischemic stroke |
| title_full_unstemmed | Collateral status, hyperglycemia, and functional outcome after acute ischemic stroke |
| title_short | Collateral status, hyperglycemia, and functional outcome after acute ischemic stroke |
| title_sort | collateral status hyperglycemia and functional outcome after acute ischemic stroke |
| topic | Intracranial collaterals Hyperglycemia Diabetes Angiography Ischemic stroke Outcome |
| url | https://doi.org/10.1186/s12883-022-02943-4 |
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