Abstract T P203: Areas of Cerebral Ischemia Have Increased Propensity to Convert to Infarct Among Diabetics

Abstract

Diabetes influences ischemic stroke outcome. While several theories are proposed, the mechanism for worse outcomes is unclear. Perfusion computed tomography (PCT) helps identify stroke patients who would benefit from endovascular therapy. Our hypothesis was that PCT could potentially be used to elucidate the biological basis of poor outcomes among diabetics with stroke Methods: Patients with ischemic stroke that underwent PCT at admission from August 2011 to March 2012 were reviewed. PCT protocol included 4 supratentorial slices, 8mm thick. Areas of increased mean transit time(MTT) were traced and marked as ischemic area. Area of preserved cerebral blood volume(CBV) was penumbra. CBV and MTT were compared among diabetics and non-diabetics. Results: The study included 44 patients: 15 diabetic and 29 non-diabetics. The age, sex, race distributions and NIH stroke scale in both groups were similar. There were no differences in risk factors such as hypertension, atrial fibrillation and smoking. The average MTT was similar for both groups in the ischemic area (8.1ml/100g in diabetics and 8.7ml/100g in non diabetics, p=0.43) and within penumbra (8.4ml/100g in diabetics and 9.2 in non diabetics, p=0.32). The CBV was significantly lower among diabetics within the ischemic area (2.8sec vs.3.5sec among nondiabetics, p=0.04) as well as penumbra (2.8sec vs. 3.6sec in nondiabetics, p=0.03). This suggests an increased propensity for penumbra to convert to infarct among diabetics. In conclusion, PCT evaluation suggests that a lower CBV could explain worse outcomes among diabetics with stroke. Microvascular disease and endothelial dysfunction should be investigated as potential mechanisms for lower CBV and worse outcomes among diabetics.