Diabetes, stroke severity and hemodynamic cerebral ischemia

Diabetes is an independent risk factor for ischemic stroke. This study was undertaken to determine whether hemodynamic cerebral ischemia (HCI), which increases stroke severity, is more frequent in diabetic patients. Between 01/01/1990 and 30/06/2019, we revascularized 4117 carotid bifurcations in 3745 patients (2687 men and 1058 women; mean age: 71 (range: 28–97) years; 940 (25.1%) diabetics and 2805 (74.9%) nondiabetics). HCI was diagnosed clinically, under regional anesthesia, when a shunt needed to be inserted. All data were included in a prospective database. The HCI rate during carotid-clamping, requiring shunt placement, was 11.0% (114/1034) for diabetics and 7.1% (219/3083) for nondiabetics (odds ratio,1.62 [95% CI, 1.27–2.05]; P < 0.0001). Diabetes was associated with increased HCI risk in our patients with carotid stenosis. This HCI-associated excess risk might explain, in part, stroke severity and heightened carotid surgical risk in diabetics.