Association of Type 2 Diabetes Mellitus and Glycemic Control With Intracranial Plaque Characteristics in Patients With Acute Ischemic Stroke

Abstract

Background: Type 2 diabetes mellitus (T2DM) has shown to be associated with carotid plaque vulnerability. However, the impact of T2DM on intracranial artery atherosclerosis is not well-understood. Purpose: To evaluate the association of diabetes and glycemic control with intracranial atherosclerotic plaque characteristics identified by three-dimensional contrast enhanced MR vessel wall imaging in patients after acute ischemic stroke. Study Type: Prospective. Population: Two hundred and eighty-eight symptomatic patients with acute ischemic stroke due to intracranial atherosclerotic plaque. Field Strength/Sequence: T 1 WI volume isotropic turbo spin-echo acquisition sequence at 3.0 T. Assessment: Clinical profiles, blood biomarkers, the number of intracranial plaques, plaque enhanced score, and the features (location, luminal stenotic rate, intraplaque hemorrhage, length, burden, enhancement grade, and ratio) of culprit plaque (defined as the most stenotic lesion ipsilateral to the ischemic event) and nonculprit plaque were analyzed by three radiologists. Statistical Tests: Analysis of variance (ANOVA), Shapiro-Wilk normality test, Levene's test, ANOVA with Bonferroni posthoc test, Kruskal Wallis H test with subsequent pairwise comparisons, chi-square with Bonferroni post-hoc test, generalized linear regression, Pearson correlation test, Kendall's W and intra-class correlation coefficient. Results: Two hundred and twenty-five participants (age 60 AE 10 years, 58.7% male) with 958 intracranial plaques were included. More intracranial plaques were found in the T2DM group than the non-T2DM group (4.80 AE 2.22 vs. 3.60 AE 1.78, P < 0.05). Patients with poorly-controlled T2DM exhibited higher culprit plaque enhancement ratio than patients with well-controlled T2DM and non-T2DM (2.32 AE 0.61 vs. 1.60 AE 0.62 and 1.39 AE 0.39; respectively, P < 0.05). After adjusting for other clinical variables, T2DM was independently associated with increased intracranial plaque number (β = 0.269, P < 0.05), and HbA1c level was independently associated with culprit plaque enhancement ratio (β = 0.641, P < 0.05) in multivariate analysis. Data Conclusion: T2DM is associated with an increased intracranial plaque number. Higher HbA1c is associated with stronger plaque enhancement. 3D contrast enhanced MR vessel wall imaging may help better understand the association of T2DM and glycemic control with intracranial plaque. Level of Evidence: 1 Technical Efficacy Stage: 3

Survey of the American Society of Neuroradiology Membership on the Use and Value of Intracranial Vessel Wall MRI

“…MR-VWI is a technique that has gained use across .50% of radiology departments that took part in this survey. The technique has shown value in vasculopathy characterization 6,7,9,10 and differentiation, [3][4][5] prediction of outcomes, 11,12 and association with patient symptoms. 6,15 To our knowledge, the current survey study is the first assessing use, approaches, vendor relations, and indications for performance of MR-VWI.…”

“…I ntracranial vessel wall MR imaging (MR-VWI) is capable of detecting, 1,2 differentiating, [3][4][5] and characterizing intracranial vasculopathies [6][7][8][9][10] and may be able to help predict patient outcomes. 11,12 Because this technique has been adopted by a growing number of institutions worldwide, the American Society of Neuroradiology (ASNR) Vessel Wall Imaging Study Group was developed to disseminate vessel wall imaging techniques, educate the general neuroradiology community on its implementation and interpretation, and influence vendors to improve vessel wall imaging techniques.…”

Optimal Medical Management of Atherosclerotic Intracranial Stenosis

“…A retrospective vessel wall magnetic resonance imaging study of 156 patients with 50% to 99% sICAS found diabetes (OR, 1.24 [95% CI, 1.04–3.79]; P =0.018) and enhancement ratios of culprit plaques (OR, 1.94 [95% CI, 1.27–3.09]; P <0.001) to be independently associated with risk of recurrent ischemic stroke. 44 Another vessel wall imaging magnetic resonance imaging study in 225 patients with sICAS found hemoglobin A1C to be an independent risk factor for higher plaque enhancement ratios, 46 perhaps demonstrating a link between poor glycemic control and high-risk plaques. Management of diabetes to a goal of glycosylated hemoglobin A1C level of ≤7 is recommended for most patients with stroke to reduce risk of microvascular complications, 14 but the goal and treatment choices should be individualized.…”

The Role of Pyroptosis and Autophagy in Ischemia Reperfusion Injury

“…Cerebral artery occlusion is the cause of the most ischemic strokes, leading to a significant increase in the global incidence rate and mortality of stroke. Diabetes is the main risk factor of ischemic stroke, which can increase its incidence rate by 1.8 to nearly 6 times and cause the poor prognosis after stroke [ 38 , 39 ]. Diabetes not only changes the structure of cerebral arteries, leading to their adverse remodeling and pathological neovascularization and vascular degeneration, but also changes the function of cerebral vessels, resulting in decreased myogenic reactivity and endothelial dysfunction.…”