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Small-vessel occlusion versus large-artery atherosclerotic strokes in diabetics: Patient characteristics, outcomes, and predictors of stroke mechanism.
Eur Stroke J. 2016 Jun; 1(2):108-113.ES

Abstract

Introduction

Diabetes mellitus exerts a detrimental effect on cerebral vasculature affecting both macrovasculature and microvasculature. However, although ischaemic stroke is typically included among macrovascular diabetic complications, it is frequently omitted from microvascular diabetic complications. We aimed to compare the proportion of large-artery atherosclerotic and small-vessel occlusion strokes among diabetic stroke patients, explore their differences and outcomes, and assess potential mechanisms which may determine why some diabetic patients suffer large-artery atherosclerotic stroke whereas others suffer small-vessel occlusion stroke.

Methods

We pooled data of diabetic patients from four prospective ischaemic stroke registries (Acute Stroke Registry and Analysis of Lausanne (ASTRAL), Athens, Austrian, and Helsinki Stroke Thrombolysis Registries). Stroke severity and prognosis were assessed with National Institutes of Health Stroke Scale (NIHSS) and ASTRAL scores, respectively; functional outcome with three-month modified Rankin score (0-2 considered as favourable outcome). Logistic-regression analysis identified independent predictors of large-artery atherosclerotic stroke.

Results

Among 5412 patients, 1069 (19.8%) were diabetics; of them, 232 (21.7%) had large-artery atherosclerotic and 205 (19.2%) small-vessel occlusion strokes. Large-artery atherosclerotic stroke had higher severity than small-vessel occlusion stroke (median NIHSS: 6 vs. 3, p < 0.001), worse prognosis (median ASTRAL score: 23 vs. 19, p < 0.001), and worse three-month outcome (60.3% vs. 83.4% with favourable outcome, p < 0.001). In logistic-regression analysis, peripheral artery disease (odds ratio: 4.013, 95% confidence interval: 1.667-9.665, p < 0.01) and smoking (odds ratio: 1.706, 95% confidence interval: 1.087-2.675, p < 0.05) were independently associated with large-artery atherosclerotic strokes.

Conclusion

In the diabetic stroke population, small-vessel occlusion and large-artery atherosclerotic strokes occur with similar frequency. Large-artery atherosclerotic strokes are more severe and have worse outcome than small-vessel occlusion strokes. The presence of peripheral artery disease and smoking independently predicted large-artery atherosclerotic stroke.

Authors+Show Affiliations

Department of Medicine, University of Thessaly, Larissa, Greece.Department of Medicine, University of Ioannina, Ioannina, Greece.Stroke Unit, Alexandra University Hospital, Athens, Greece.Department of Medicine, University of Thessaly, Larissa, Greece. Stroke Unit, Alexandra University Hospital, Athens, Greece.Department of Neurology, St John of God Hospital, Vienna, Austria.Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland.Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland.Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland. Institute of Neuroscience and Physiology, Sahlgrenska Academy in University of Gothenburg, Gothenburg, Sweden. Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden.Stroke Center, University of Lausanne, Lausanne, Switzerland.Department of Medicine, University of Thessaly, Larissa, Greece. School of Medicine, University of Leeds & Leeds Teaching Hospitals NHS Trust, Leeds, UK.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31008272

Citation

Ntaios, G, et al. "Small-vessel Occlusion Versus Large-artery Atherosclerotic Strokes in Diabetics: Patient Characteristics, Outcomes, and Predictors of Stroke Mechanism." European Stroke Journal, vol. 1, no. 2, 2016, pp. 108-113.
Ntaios G, Milionis H, Vemmos K, et al. Small-vessel occlusion versus large-artery atherosclerotic strokes in diabetics: Patient characteristics, outcomes, and predictors of stroke mechanism. European stroke journal. 2016;1(2):108-113.
Ntaios, G., Milionis, H., Vemmos, K., Makaritsis, K., Ferrari, J., Strbian, D., Curtze, S., Tatlisumak, T., Michel, P., & Papavasileiou, V. (2016). Small-vessel occlusion versus large-artery atherosclerotic strokes in diabetics: Patient characteristics, outcomes, and predictors of stroke mechanism. European Stroke Journal, 1(2), 108-113. https://doi.org/10.1177/2396987316647856
Ntaios G, et al. Small-vessel Occlusion Versus Large-artery Atherosclerotic Strokes in Diabetics: Patient Characteristics, Outcomes, and Predictors of Stroke Mechanism. European stroke journal. 2016;1(2):108-113. PubMed PMID: 31008272.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Small-vessel occlusion versus large-artery atherosclerotic strokes in diabetics: Patient characteristics, outcomes, and predictors of stroke mechanism. AU - Ntaios,G, AU - Milionis,H, AU - Vemmos,K, AU - Makaritsis,K, AU - Ferrari,J, AU - Strbian,D, AU - Curtze,S, AU - Tatlisumak,T, AU - Michel,P, AU - Papavasileiou,V, Y1 - 2016/05/05/ PY - 2015/12/15/received PY - 2016/04/12/accepted PY - 2019/4/23/entrez PY - 2016/6/1/pubmed PY - 2016/6/1/medline KW - Ischaemic stroke KW - diabetic complications KW - large-artery atherosclerotic KW - macrovascular KW - microvascular KW - small-vessel occlusion SP - 108 EP - 113 JF - European stroke journal VL - 1 IS - 2 N2 - Introduction: Diabetes mellitus exerts a detrimental effect on cerebral vasculature affecting both macrovasculature and microvasculature. However, although ischaemic stroke is typically included among macrovascular diabetic complications, it is frequently omitted from microvascular diabetic complications. We aimed to compare the proportion of large-artery atherosclerotic and small-vessel occlusion strokes among diabetic stroke patients, explore their differences and outcomes, and assess potential mechanisms which may determine why some diabetic patients suffer large-artery atherosclerotic stroke whereas others suffer small-vessel occlusion stroke. Methods: We pooled data of diabetic patients from four prospective ischaemic stroke registries (Acute Stroke Registry and Analysis of Lausanne (ASTRAL), Athens, Austrian, and Helsinki Stroke Thrombolysis Registries). Stroke severity and prognosis were assessed with National Institutes of Health Stroke Scale (NIHSS) and ASTRAL scores, respectively; functional outcome with three-month modified Rankin score (0-2 considered as favourable outcome). Logistic-regression analysis identified independent predictors of large-artery atherosclerotic stroke. Results: Among 5412 patients, 1069 (19.8%) were diabetics; of them, 232 (21.7%) had large-artery atherosclerotic and 205 (19.2%) small-vessel occlusion strokes. Large-artery atherosclerotic stroke had higher severity than small-vessel occlusion stroke (median NIHSS: 6 vs. 3, p < 0.001), worse prognosis (median ASTRAL score: 23 vs. 19, p < 0.001), and worse three-month outcome (60.3% vs. 83.4% with favourable outcome, p < 0.001). In logistic-regression analysis, peripheral artery disease (odds ratio: 4.013, 95% confidence interval: 1.667-9.665, p < 0.01) and smoking (odds ratio: 1.706, 95% confidence interval: 1.087-2.675, p < 0.05) were independently associated with large-artery atherosclerotic strokes. Conclusion: In the diabetic stroke population, small-vessel occlusion and large-artery atherosclerotic strokes occur with similar frequency. Large-artery atherosclerotic strokes are more severe and have worse outcome than small-vessel occlusion strokes. The presence of peripheral artery disease and smoking independently predicted large-artery atherosclerotic stroke. SN - 2396-9881 UR - https://www.unboundmedicine.com/medline/citation/31008272/Small_vessel_occlusion_versus_large_artery_atherosclerotic_strokes_in_diabetics:_Patient_characteristics_outcomes_and_predictors_of_stroke_mechanism_ L2 - https://www.ncbi.nlm.nih.gov/pmc/articles/pmid/31008272/ DB - PRIME DP - Unbound Medicine ER -
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