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Ischemic stroke and reperfusion therapies in diabetic patients

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Abstract

Introduction

The study aimed to identify the main prognostic factors in diabetic patients with ischemic stroke undergoing reperfusion therapies (RT).

Methods

This retrospective study included 170 diabetic patients: 62 treated with intravenous thrombolysis (IVT) alone and 108 with mechanical thrombectomy (MT). Among MT patients, 29 underwent IVT. We collected clinical, laboratory, and radiological data. The outcomes were 3-month functional impairment (measured by modified Rankin scale, mRs), discharge neurological severity (measured by National Institutes of Health Stroke Scale score, NIHSS), 3-month mortality, intracranial hemorrhage (ICH), and symptomatic intracranial hemorrhage (SICH). We performed a general analysis for all RT and sub-group analyses for IVT and MT.

Results

A lower mRs was associated with lower glycemia and admission NIHSS (aNIHSS) in all RT and MT; lower aNIHSS and younger age in IVT. Mortality increased with hyperglycemia, aNIHSS, and age in all RT; age and aNIHSS in IVT; hyperglycemia and systolic pressure in MT. A lower discharge NIHSS was related with lower aNIHSS, thrombolysis, and no thrombectomy in all RT; lower aNIHSS in IVT; lower aNIHSS and thrombolysis in MT. ICH was associated with elevated aNIHSS, older age, and lower platelets in all RT; lower platelets and older age in IVT; higher aNIHSS in MT. SICH depended on longer thrombectomy duration in all RT; no metformin use in IVT; higher weight in MT.

Conclusion

The study shed light on diabetic patients and stroke RT highlighting the protective effect of metformin in IVT and the role of glycemia, weight, and combined treatment in MT.

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Data availability

Derived data supporting the findings of this study are available from the corresponding author on request.

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Acknowledgements

We would like to thank L.R., C.A., and C.M.L. for the strong support in these years; F.F. for the opportunity; A.G., M.A., and R.S. for the long and strong partnership; N.G., Z.V., and C.A. for the partnership and the support in these unforgettable years; C.A. also for the method, the advices, the spark, and the research interest in common; F.I., V.C., and G.F. for the partnership, the advices, and for being an example; C.D., D.J., G.A., and F.G. for the partnership and their limitless kindness; C.M. for believing in us from the beginning; D.C. for being a wonderful person; M.R. for the motivation; and all members of our neurology department in particular the physicians in training.

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Authors and Affiliations

  1. Department of Clinical and Experimental Medicine, University of Messina, Via Consolare Valeria 1, 98124, Messina, Italy

    Carmelo Tiberio Currò, Giulia Fiume, Masina Cotroneo, Giuseppina Russo, Carmela Casella, Cristina Dell’Aera, Maria Carolina Fazio, Francesco Grillo, Angelina Laganà, Antonio Toscano, Rosa Fortunata Musolino & Paolino La Spina

  2. Faculty of Medicine and Surgery, University of Messina, Messina, Italy

    Giuseppe Trimarchi

  3. Neuroradiology Unit, Biomedical Sciences and of Morphologic and Functional Images, University of Messina, Messina, Italy

    Sergio Lucio Vinci

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  1. Carmelo Tiberio Currò
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Contributions

C.C.T. contributed to the study design; C.C.T., C.M., P.A., L.M., V.S.L., F.M.C., G.F., and D.C. performed the data collection; T.G. performed the statistical analysis; C.M., G.R., L.P., C.C., T.A., L.M., G.F., and M.R.F. supervised the research; C.C.T., F.G., M.R.F., and R.G. wrote the article.

Corresponding author

Correspondence to Carmelo Tiberio Currò.

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The research was conducted ethically in accordance with the World Medical Association Declaration of Helsinki. The study protocol has been approved by the research institute’s committee on human research.

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All the patients have given their written informed consent.

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The authors declare no competing interests.

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Currò, C.T., Fiume, G., Cotroneo, M. et al. Ischemic stroke and reperfusion therapies in diabetic patients. Neurol Sci 43, 4335–4348 (2022). https://doi.org/10.1007/s10072-022-05935-x

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