title: The impact of diabetes on the extent of pial collaterals in acute ischemic stroke patients.
abstract: BACKGROUND
  The threatened vascular territory in ischemic stroke is maintained by pial collateral circulation. Neovascularization varies among organ systems in diabetic patients. The effect of diabetes on the extent of pial collaterals is not well known. The pial collateral supply was compared among diabetic and non-diabetic patients presenting with acute ischemic stroke.
  
  
  METHODS
  Databases from two institutions were accessed to identify all patients who presented with acute middle cerebral artery occlusion and underwent emergent cerebral angiography. Angiograms were reviewed and graded using a previously published pial collateral grading system. The collateral grading system was dichotomized into good (pial grades 1-2) and poor (pial grades 3-5). A χ2 analysis was performed to compare the association between diabetes and pial collateral grade.
  
  
  RESULTS
  104 patients were identified; 56 (54%) patients were men, mean age was 63.5 years and 22 (21%) patients had diabetes. Mean admission National Institutes of Health Stroke Scale was 15.7. In the diabetic population, 15 (68.2%) patients had good pial collaterals while seven (31.8%) patients had poor pial collaterals. In the non-diabetic population, 59 (71.9%) patients had good pial collaterals while 23 (28.0%) patients had poor pial collaterals. There was no association between diabetes and pial collateral grade (p=0.7290, Pearson χ2).
  
  
  CONCLUSIONS
  This series suggests there is no association between diabetes and the extent of pial collaterals in ischemic stroke patients. Further studies are warranted to understand pial collateral patterns in acute ischemic stroke patients and their impact on clinical outcomes.
authors: Froedtert Hospital and Medical College of Wisconsin, Milwaukee, Wisconsin 53226, USA. mlazzaro2@gmail.com
authors: Marc A
authors: MA
authors: Lazzaro
authors: Michael
authors: M
authors: Chen
authors: Gregory A
authors: GA
authors: Christoforidis
authors: Yousef
authors: Y
authors: Mohammad
mesh_terms: D003097:Collateral Circulation / Q000502:physiology*; D048909:Diabetes Complications / Q000503:physiopathology*; D005260:Female; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000150:complications* / Q000000981:diagnostic imaging / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D010841:Pia Mater / Q000098:blood supply*; D011859:Radiography; D012189:Retrospective Studies; D012720:Severity of Illness Index