The impact of diabetes on the extent of pial collaterals in acute ischemic stroke patients
- 1Froedtert Hospital and Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- 2Rush University Medical Center, Chicago, Illinois, USA
- 3The University of Chicago, Chicago, Illinois, USA
- Correspondence to Dr M A Lazzaro, Medical College of Wisconsin, Department of Neurology, 9200 West Wisconsin Avenue, Milwaukee, WI 53226, USA;
- Received 14 December 2010
- Accepted 7 January 2011
- Published Online First 1 February 2011
Introduction The threatened vascular territory in ischemic stroke is maintained by pial collateral circulation. Neovascularization varies among organ systems in diabetic patients. The effect of diabetes on the extent of pial collaterals is not well known. The pial collateral supply was compared among diabetic and non-diabetic patients presenting with acute ischemic stroke.
Material and methods Databases from two institutions were accessed to identify all patients who presented with acute middle cerebral artery occlusion and underwent emergent cerebral angiography. Angiograms were reviewed and graded using a previously published pial collateral grading system. The collateral grading system was dichotomized into good (pial grades 1–2) and poor (pial grades 3–5). A χ2 analysis was performed to compare the association between diabetes and pial collateral grade.
Results 104 patients were identified; 56 (54%) patients were men, mean age was 63.5 years and 22 (21%) patients had diabetes. Mean admission National Institutes of Health Stroke Scale was 15.7. In the diabetic population, 15 (68.2%) patients had good pial collaterals while seven (31.8%) patients had poor pial collaterals. In the non-diabetic population, 59 (71.9%) patients had good pial collaterals while 23 (28.0%) patients had poor pial collaterals. There was no association between diabetes and pial collateral grade (p=0.7290, Pearson χ2).
Conclusions This series suggests there is no association between diabetes and the extent of pial collaterals in ischemic stroke patients. Further studies are warranted to understand pial collateral patterns in acute ischemic stroke patients and their impact on clinical outcomes.
Competing interests None.
Ethics approval This study was conducted with the approval of the Rush University Medical Center Institutional Review Board and Ohio State University Institutional Review Board.
Provenance and peer review Not commissioned; externally peer reviewed.