Clinical Study Of Characteristics Of Ischaemic Stroke And Patency Of The Circle Of Willis In Patient With Diabetic Mellitus

Part One Patterns of ischaemic stroke in patient with diabetic mellitusObjective:Stroke was categorized according to ischaemic site and amount of blood supply:(1)anterior circulation cerebral infarction(ACCI),which included lesions from the internal carotid artery blood supply that affected the frontal lobe,parietal lobe,lateral temporal lobe,putamen,caudate nucleus,anterior limb of the internal capsule,genu of internal capsule,and the anterior 2/3 of the posterior limb of the internal capsule;(2)posterior cerebral artery cerebral infarction(excluding the P1 segment,PCACI),which included the occipital lobe and the medial temporal lobe,and the 1/3 hypothalamus parts lateral to the posterior limb of the internal capsule;and(3)vertebral basilar artery infarction and posterior cerebral artery P1 segment infarction(PCACI),which included the medulla,pons,midbrain,cerebellum,and medial thalamus.This research is to determine the topography pattern of ischaemic stroke in patients with,diabetes mellitus(anterior circulation,vertebrabasilar artery and posterior cerebral artery blood supply).Methods:Retrospectively studying consecutive patients with acute ischaemic stroke treated in our hospital between July 2011 and May 2016.They were divided into diabetic group and non-diabetic group.Stroke risk factors of two groups,including hypertension,hyperlipidemia,hyperuricemia,hyperhomocysteinemia,atrial fibrillation,stroke history and smoking history were compared.Cerebral infarction site was confirmed by magnetic resonance diffusion-weighted imaging.Ischaemic stroke was categorized according to ischaemic site and amount of blood supply:(1)ACCI,which included lesions from the internal carotid artery blood supply that affected the frontal lobe,parietal lobe,lateral temporal lobe,putamen,caudate nucleus,anterior limb of the internal capsule,genu of internal capsule,and the anterior 2/3 of the posterior limb of the internal capsule;(2)PCACI,which included the occipital lobe and the medial temporal lobe,and the 1/3 hypothalamus parts lateral to the posterior limb of the internal capsule;and(3)VBACI,which included the medulla,pons,midbrain,cerebellum,and medial thalamus.Results:1.Population characteristics:A total of 1406 patients entered the study,412 patients with diabetes and 994 without diabetes.The mean age of the patients in the diabetic group was 62.2 ± 11.0 years and 262 were male,accounting for 63.6%of the group.The mean age of patients without diabetes was 60.9±12.8 years and 662 were male accounting for 66.6%of the group.There was no significant difference between two groups in age and gender.2.Risk factors:Age,gender,smoking,family history of stroke,stroke history,hyperhomocysteinaemia,hyperuricemia,and atrial fibrillation were similar between patients with or without diabetes(all P>0.05).The proportions of patients with hypertension and hyperlipidaemia were higher in the diabetes group(hypertension,326/412[79.1%]versus 618/994[62.2%],P<0.05;hyperlipidaemia:200/412[48.5%]versus 360/994[36.2%],P<0.05;Logistic regression analysis including age,gender,smoking,family history of stroke,stroke history,hyperhomocysteinaemia,hyperuricemia,atrial fibrillation hypertension and hyperlipidaemia showed that hypertension(odds ratio[OR]2.29;95%confidence interval[CI]1.699,2.924;P<0.05)and hyperlipidaemia(odds ratio[OR]1.580;95%confidence interval[CI]1.248,2.000;P<0.05)were independently associated with ischaemic stroke in diabetic patients.3.Stroke patterns:Among the 1406 patients,926(68.7%)had ACCI,364(25.9%)had VBACI,and 116(8.3%)had PCACI.In the diabetic subgroup of 412 patients,there were 222(53.9%)with ACCI,142(35.5%)with VBACI,48(11.7%)with PCACI;Among the 994 patients in non-diabetic subgroups,there were 704(70.8%)with ACCI,222(22.3%)with VBACI,and 68(6.8%)with PCACI,composition ratio of different cerebral infarction sites in diabetic group and non-diabetic group was different(P<0.05).When performing multiple comparisons,compared with ACCI,the frequency of VBACI and PCACI were significantly higher in diabetic group(P<0.0125),compared with VBACI,the frequency of PCACI was not significantly different between the two groups(P>0.0125).Conclusion:Different risk factors have different effects on ischaemic stroke,in patients with ischaemic stroke,who with diabetes are more likely to develop cerebral infarction in the posterior circulation area.Diabetes may be a important history in the early diagnosis of ischaemic stroke in posterior circulation.Part Two Association between patency of the circle of Willis and diabetes mellitus in patients with ischaemic strokeObjective:To investigate the patency of the anterior and posterior communicating arteries of patients with ischemic stroke complicated with diabetes mellitus,and the patency of the anterior and posterior communicating arteries in patients with diabetes mellitus after posterior circulation stroke.Methods:Retrospectively studying consecutive patients with acute ischaemic stroke treated in our hospital between July 2011 and May 2016.They were divided into diabetic group and non-diabetic group.Magnetic resonance angiography(MRA)was used to detect the opening of the anterior and posterior communicating arteries.The potency of the anterior communicating artery(ACoA)was recorded as 1(patent)or 0(non-patent[occluded])according to the MRA evaluation.For the posterior communicating artery(PCoA),bilateral occlusion was recorded as 0,unilateral occlusion was recorded as 1,and bilateral patency was recorded as 2.(1)To analyze whether the patency rates of anterior and posterior communicating arteries was different between diabetic and non-diabetic groups.And(2)the study whether there was a difference of patency rate of anterior and posterior communicating arteries between two groups with different type of ischaemic stroke described in the first part.Results:(1)Overall patency rates of the anterior and posterior communicating arteries were determined.In patients with diabetes mellitus compared with non-diabetes mellitus,for the ACoA patency(51.0%v.s.41.2%,P<0.05);for the PCoA(non,unilateral,bilateral)patency(55.6%,26.9%,17.5%v.s.64.4%,22.3%,13.3%,P<0.05).(2)Patency rates of the anterior and posterior communicating arteries were determined according to infarction site.?In the ACCI subgroup,in patients with diabetes mellitus compared with non-diabetes mellitus,for the ACoA patency(43.2%v.s.41.5%,P>0.05),for the PCoA(non,unilateral,bilateral)patency(55.4%,25.7%,18.9%v.s.66.2%,22.4%,15.3%,P>0.05);?In the VBACI subgroup,in patients with diabetes mellitus compared with non-diabetes mellitus,for the ACoA patency(57.7%v.s.45.9%,P<0.05),for the PCoA(non,unilateral,bilateral)patency(66.2%,23.9%,9.9%v.s.65.8%,25.2%,9.0%,P>0.05);?In the PCACI subgroup,in patients with diabetes mellitus compared with non-diabetes mellitus,for the ACoA patency(66.7%v.s.23.5%,P<0.05),for the PCoA(non,unilateral,bilateral)patency(25.0%?41.7%?33.3%v.s.82.4%?11.8%?5.9%,P<0.05)Conclusion:The patency rates of circle of Willis in diabetic patients with ischaemic stroke may be higher than that in non-diabetic patients,which is more pronounced in posterior circulation ischaemic stroke.This difference may be the result of imbalance of atherosclerosis between anterior and posterior circulation caused by diabetes mellitus.