Abstract
ObjectivesThe association of branch atherosclerotic disease (BAD) and diabetes mellitus (DM) in the territory of posterior circulation is rarely discussed. Intracranial BAD was divided into two different types: paramedian pontine arteries (PPA) disease (PPD) and lenticulostriate arteries (LSA) disease. The goal of the study was to evaluate the clinical characteristics of PPD and its association with hemoglobinA1c (HbA1c) in China.Materials and MethodsRadiologically confirmed PPD was defined as an isolated unilateral infarction extending to the ventral surface of the pons. Small deep cerebral infarctions are usually caused by two different pathological changes of arteries: BAD and lipohyalinotic degeneration (LD). We compared the vascular risk factors between BAD and LD in PPA territory. A total of 159 stroke patients were analyzed (PPD, n = 75; LD, n = 84). Patients with PPD were also categorized into two groups according to follow‐up modified Rankin Scale (FmRS) scores. Logistic regression analyses were used for the evaluation of independent risk factors of PPD and prognosis.ResultsComparison between PPD and LD revealed statistical significance in fasting glucose, HbA1c, estimated glomerular filtration rate (eGFR), and uric acid (p = .011, p = .005, p = .027, p = .018, respectively). Compared with LD, PPD was only related to HbA1c (p = .011) in logistic regression analysis. There were statistically significant differences between the two groups based on the stratification of FmRS scores in fasting glucose, HbA1c, homocysteine, eGFR, and the occurrence of DM. After multivariate analysis, only HbA1c was related with poor prognosis of PPD (p = .002).ConclusionsThe subtypes and prognosis of small deep brain infarcts are significantly influenced by elevated HbA1c level in PPA territory. DM might play an important role in the pathogenesis of PPD.
Highlights
Glycosylated hemoglobinA1c (HbA1c) reflects the average fasting and postprandial blood glucose over a period of 2 to 3 months and is clinically used to evaluate diabetes control (Egoldstein, 2004)
Small deep cerebral infarctions are usually caused by two different pathological changes of arteries: branch atheromatous disease (BAD) and lipohyalinotic degeneration (LD), which is mainly caused by lipid degeneration in the process of penetrating arteries (Baumgartner, Sidler, Mosso, & Georgiadis, 2003; Caplan, 1989)
Few studies have focused on prognosis of BAD in paramedian pontine arteries (PPA) territory and the risk factors of BAD in the territory, compared to LD
Summary
Glycosylated hemoglobinA1c (HbA1c) reflects the average fasting and postprandial blood glucose over a period of 2 to 3 months and is clinically used to evaluate diabetes control (Egoldstein, 2004). Caplan suggested that intracranial branch atheromatous disease (BAD) was the fourth etiological factor of small deep cerebral infarction (Caplan, 1989). It is a common stroke subtype of Asian populations and has drawn more and more attention in recent years. Our previous study, which represented all of acute ischemic stroke patients, showed that DM or HbA1c was not significantly related to progression and poor outcome of BAD (Men, Li, et al, 2013; Men, Wu, et al, 2013). To identify the traditional vascular risk factors that have different effects on PPD, we conducted a clinical and radiological investigation of the relationship of HbA1c levels with Chinese patients with PPD and evaluated whether HbA1c may be an independent risk factor for PPD vasculopathy and its prognosis
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