Diabetes mellitus inhibits complete recanalization in patients with middle cerebral artery occlusion

ABSTRACT

Methods: This was a retrospective cohort study. Data from 165 patients, with middle cerebral occlusion before t-PA therapy (from the YAMATO study databank), were retrospectively evaluated. Patients were classified into diabetic (D) or non-diabetic (ND) groups based on the history of diabetes mellitus (DM) or hemoglobin A1c levels of ≥ 6.5%. Arterial recanalization was assessed using magnetic resonance angiography or digital subtraction angiography at 2 points: 1) early recanalization, within 2 h; 2) delayed complete recanalization at 24 h. Good clinical outcome was defined as modified Rankin Scale score 0–2 at 3 months.

Results: A total of 33 (21%) were classified into the D and 127 (79%) in the ND groups. Early recanalization was similarly in the D and ND groups (61% vs. 52%, p = 0.434). However, complete recanalization at 24 h was infrequent in the D group (13% vs. 43%, p = 0.002). Among patients with early recanalization, 4 (22%) of 18 patients in the D group and 32 (56%) of 57 patients in the ND group had complete recanalization at 24 h (p = 0.015); while among those without early recanalization, 17 (30%) in the ND and none in the D groups had complete recanalization at 24 h (p = 0.028). Multivariate regression analysis showed DM was one of the independent negative factors for complete recanalization at 24 h (odds ratio 0.113, 95%CI: 0.027–0.472, p = 0.003). At 3 months, group with complete recanalization at 24 h achieved higher frequency of good outcome (67% vs. 49%, p = 0.046).

Conclusion: Diabetes might be a risk factor of incomplete recanalization at 24 h regardless of early recanalization.

KEYWORDS:

• Diabetes mellitus
• intravenous thrombolysis
• recanalization
• middle cerebral artery occlusion
• clinical outcome

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Notes on contributors

Junya Aoki

Junya Aoki is Associate Professor at Graduate School of Medicine, Nippon Medical School, Tokyo. He graduated from Fukushima Medical University, Fukushima, where he started neurology training. From 2007 to 2014, he studied vascular neurology at Kawasaki Medical School, Okayama, where he received his PhD in medicine. From 2010 to 2011, he stayed at the Cerebrovascular Center, Cleveland Clinic, Ohio, United States, as a research fellow. His research interests include intravenous thrombolysis, ultrasound examination, and endovascular therapy.

Kazumi Kimura

Dr. Kazumi Kimura is Professor and Director of Neurology and Stroke Medicine at Nippon Medical School, Tokyo. He was the founder and the first professor of the department of Stroke Medicine within medical schools in Japan.

Naomi Morita

Dr. Naomi Morita is a radiologist at Iseikai Hospital, Osaka. Before she came to Iseikai Hospital, she was at the Tokushima University and National Cerebral and Cardiovascular Center, Osaka.

Masafumi Harada

Dr. Masafumi Harada is Professor and Director of Department of Radiology, Tokushima University. He has many Grants-in-Aid for Scientific Research, from the Ministry of Education, Culture, Sports, Science and Technology, Japan. His researches include neuroimaging using high field MRI.

Shinji Nagahiro

Dr. Shinji Nagahiro is Director of Tokushima University Hospital and a prior Professor and Director of Department of neurosurgery, Tokushima University. He also has many Grants-in-Aid for Scientific Research, from the Ministry of Education, Culture, Sports, Science and Technology, Japan for decades.