. 2022 Nov 4;22(1):408.

doi: 10.1186/s12883-022-02943-4.

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

Daniel F Arteaga¹, Robin Ulep², Kevin K Kumar³, Andrew M Southerland⁴, Mark R Conaway⁵, James Faber⁶, Max Wintermark⁷, David Joyner⁸, Vera Sharashidze⁹, Karen Hirsch², Dan-Victor Giurgiutiu¹⁰, Yousef Hannawi¹¹, Yasmin Aziz¹², Lori Shutter¹³, Anita Visweswaran², Alana Williams⁹, Kori Williams¹⁰, Sonya Gunter⁴, Heather M Haughey⁴, Askiel Bruno¹⁰, Karen C Johnston⁴, Vishal N Patel⁹; SHINE Trial Investigators

Affiliations

¹ Department Neurology, St Thomas Rutherford Hospital, Murfreesboro, 1700 Medical Center Pkwy, Murfreesboro, TN, 37129, USA. darteaga08@gmail.com.
² Department of Neurology, Stanford University, Stanford, CA, USA.
³ Department of Neurosurgery, Stanford University, Stanford, CA, USA.
⁴ Department of Neurology, University of Virginia, Charlottesville, VA, USA.
⁵ Department of Statistics, University of Virginia, Charlottesville, VA, USA.
⁶ Department of Cell Biology and Physiology, University of North Carolina, Chapel Hill, NC, USA.
⁷ Department of Radiology, Stanford University, Stanford, CA, USA.
⁸ Department of Radiology, University of Virginia, Charlottesville, VA, USA.
⁹ Department of Neurology, Emory University, Atlanta, GA, USA.
¹⁰ Department of Neurology, Medical College of Georgia at Augusta University, Augusta, GA, USA.
¹¹ Department of Neurology, The Ohio State University, Columbus, OH, USA.
¹² Department of Neurology, University of Pittsburgh, Pittsburgh, PA, USA.
¹³ Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, USA.

PMID: 36333676
PMCID: PMC9635077
DOI: 10.1186/s12883-022-02943-4

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

Daniel F Arteaga et al. BMC Neurol. 2022.

. 2022 Nov 4;22(1):408.

doi: 10.1186/s12883-022-02943-4.

Authors

Affiliations

¹ Department Neurology, St Thomas Rutherford Hospital, Murfreesboro, 1700 Medical Center Pkwy, Murfreesboro, TN, 37129, USA. darteaga08@gmail.com.
² Department of Neurology, Stanford University, Stanford, CA, USA.
³ Department of Neurosurgery, Stanford University, Stanford, CA, USA.
⁴ Department of Neurology, University of Virginia, Charlottesville, VA, USA.
⁵ Department of Statistics, University of Virginia, Charlottesville, VA, USA.
⁶ Department of Cell Biology and Physiology, University of North Carolina, Chapel Hill, NC, USA.
⁷ Department of Radiology, Stanford University, Stanford, CA, USA.
⁸ Department of Radiology, University of Virginia, Charlottesville, VA, USA.
⁹ Department of Neurology, Emory University, Atlanta, GA, USA.
¹⁰ Department of Neurology, Medical College of Georgia at Augusta University, Augusta, GA, USA.
¹¹ Department of Neurology, The Ohio State University, Columbus, OH, USA.
¹² Department of Neurology, University of Pittsburgh, Pittsburgh, PA, USA.
¹³ Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, USA.

PMID: 36333676
PMCID: PMC9635077
DOI: 10.1186/s12883-022-02943-4

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.

Keywords: Angiography; Diabetes; Hyperglycemia; Intracranial collaterals; Ischemic stroke; Outcome.

PubMed Disclaimer

Conflict of interest statement

AMS discloses research support from the American Heart Association, Diffusion Pharmaceuticals, Inc. and Abbvie, Inc. He also performs paid expert consultation in medical legal review of stroke related cases.

Figures

**Fig. 1**
Association between collateral grade and 90-day mRS. mRS = modified Rankin Scale

See this image and copyright information in PMC

References

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

Affiliations

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

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

MeSH terms

Substances

Associated data

Grants and funding

LinkOut - more resources

Full Text Sources

Medical