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

Area of Science:

• Neurology
• Stroke Research
• Medical Imaging

Background:

• Hyperglycemia's effect on stroke outcomes is debated, especially with collateral flow.
• Leptomeningeal collateral status may influence stroke recovery.
• The Stroke Hyperglycemia Insulin Network Effort (SHINE) trial investigated glucose control in stroke patients.

Purpose of the Study:

• To examine if collateral status modifies the association between glucose control treatment and functional outcome.
• To analyze a subset of patients with large vessel occlusion from the SHINE trial.

Main Methods:

• Post-hoc analysis of 57 patients with anterior circulation large vessel occlusion from the SHINE trial.
• CT angiography used to assess collateral status prior to treatment.
• Logistic regression analyzed functional outcome (90-day modified Rankin Scale) adjusted for key clinical factors.

Main Results:

• Collateral status did not significantly modify the association between glucose control treatment and functional outcome (p=0.855).
• Patients with good collaterals showed a significantly higher likelihood of favorable functional outcomes (p=0.001, OR 5.02).

Conclusions:

• Collateral status does not appear to modify the impact of glucose control interventions on functional outcomes in large vessel occlusion stroke.
• Good collateral flow remains a significant predictor of favorable outcomes in these patients.