Cerebrovascular Complications of Diabetes: Focus on Stroke

Ergul, Adviye; Kelly-Cobbs, Aisha I.; Abdalla, Maha; Fagan, Susan C.

doi:10.2174/187153012800493477

Cited by 164 publications

(116 citation statements)

References 107 publications

Supporting

Mentioning

108

Contrasting

Unclassified

Order By: Relevance

“…17 Furthermore, it is well known that patients with DM tend to develop stroke events in cerebrovascular and cardiovascular diseases. 4,8,13 In our cohort, all adult patients underwent EDAS. Adequate pial collateral vessel formation, and improvement in clinical outcomes and mRS scores, in addition to a reduced number of stroke events, were observed in both groups in our study.…”

Section: Surgical Treatmentmentioning

confidence: 99%

See 1 more Smart Citation

Surgical outcomes following encephaloduroarteriosynangiosis in adult moyamoya disease associated with Type 2 diabetes

Ren

Zhang

Liu

et al. 2016

JNS

View full text Add to dashboard Cite

M oyaMoya disease (MMD), a cerebral vascular disease, is characterized by progressive stenosis and occlusion of the terminal portion of the bilateral internal carotid arteries, leading to the formation of an abnormal vascular network composed of collateral pathways at the base of the brain. MMD can cause a reduction in the blood supply to the brain, and there are 2 major etiological categories of symptoms: those due to brain ischemia (i.e., stroke, transient ischemic attack, and seizure) and those due to the deleterious consequences of the compensatory mechanisms in response to ischemia (i.e., hemorrhage from fragile collateral vessels and headache aBBreViatiONS CBF = cerebral blood flow; DM = diabetes mellitus; EDAS = encephaloduroarteriosynangiosis; MCA = middle cerebral artery; MMD = moyamoya disease; mRS = modified Rankin Scale; PCA = posterior cerebral artery; STA = superficial temporal artery; T2DM = Type 2 DM. SuBmitted January 29, 2015. OBJectiVe Debate exists regarding the merits and shortcomings of an indirect bypass procedure for treating adult patients with moyamoya disease (MMD). Considerable variation in neovascularization occurs among different organs in patients with diabetes mellitus. Here, the effect of encephaloduroarteriosynangiosis on MMD associated with Type 2 diabetes mellitus (T2DM) is evaluated. methOdS A retrospective and 1:2 matched case-control study was conducted in moyamoya patients with or without T2DM (n = 180). Postoperative collateral formations were graded according to the Modified Collateral Grading System that originated from the Matsushima Angiographic Stage Classification. Neurological function outcomes before and after the operation were evaluated according to the modified Rankin Scale. Univariate and multivariate logistic regression analyses were performed to determine the risk factors for clinical outcome. reSultS There was no statistically significant difference in the constituent ratios of initial symptom and preoperative Suzuki stage between patients with and without T2DM. Progression of angiopathy around the circle of Willis was postoperatively observed in bilateral internal carotid arteries in both groups. Patients with T2DM had a higher postoperative Suzuki stage (p < 0.01) and more frequent development of collateral angiogenesis germinating from the external carotid after indirect revascularization procedures in the surgical cerebral hemisphere (82.7% vs 72.2%; p < 0.05). The extent of postoperative collateral formation in patients with diabetes mellitus was significantly higher (p < 0.01). Postoperative clinical improvement in the diabetes group was more common after revascularization procedures (p < 0.05), and the diabetes group had lower modified Rankin Scale scores (p < 0.05) in comparison with the nondiabetes group. Late postoperative stroke and posterior cerebral artery involvement were identified as predictors of unfavorable clinical outcome in both groups, while T2DM was associated with a favorable clinical outcome. cONcluSiONS Encephaloduroarteriosynangio...

show abstract

Section: Surgical Treatmentmentioning

confidence: 99%

“…4,8,13 Different outcomes of neovascularization attributed to DM have been found in various organ systems. 1,10,19,26 The effect of DM on cerebral neovascularization remains unclear.…”

mentioning

confidence: 99%

Surgical outcomes following encephaloduroarteriosynangiosis in adult moyamoya disease associated with Type 2 diabetes

Ren

Zhang

Liu

et al. 2016

JNS

View full text Add to dashboard Cite

show abstract

“…Diabetes increases the risk of a number of neurologic disorders including stroke, vascular cognitive impairment, and Alzheimer's disease, in all of which the cerebrovasculature has an important role in disease onset, progression, and treatment. 6 On the basis of the fact that diabetes is the most rapidly increasing risk factor for stroke, stroke is the leading cause of disability, and reparative angiogenesis is being pursued as a therapeutic strategy, the purpose of this review is to take a closer look at cerebral neovascularization in diabetes and stroke.…”

Section: Introductionmentioning

confidence: 99%

Cerebral Neovascularization in Diabetes: Implications for Stroke Recovery and beyond

Ergul

Abdelsaid

Fouda

et al. 2014

J Cereb Blood Flow Metab

Self Cite

View full text Add to dashboard Cite

Neovascularization is an innate physiologic response by which tissues respond to various stimuli through collateral remodeling (arteriogenesis) and new vessel formation from existing vessels (angiogenesis) or from endothelial progenitor cells (vasculogenesis). Diabetes has a major impact on the neovascularization process but the response varies between different organ systems. While excessive angiogenesis complicates diabetic retinopathy, impaired neovascularization contributes to coronary and peripheral complications of diabetes. How diabetes influences cerebral neovascularization remained unresolved until recently. Diabetes is also a major risk factor for stroke and poor recovery after stroke. In this review, we discuss the impact of diabetes, stroke, and diabetic stroke on cerebral neovascularization, explore potential mechanisms involved in diabetes-mediated neovascularization as well as the effects of the diabetic milieu on poststroke neovascularization and recovery, and finally discuss the clinical implications of these effects.

show abstract

“…Epidemiological studies have shown that patients with diabetes suffer higher stroke mortality (5). Those who survive are more likely to suffer severe disability and exhibit slower short-and long-term recovery than patients without diabetes (1,2,6).…”

Section: Impaired Stroke Recovery In Rodent Models Of Diabetesmentioning

confidence: 99%

“…To this end, the present review focuses on experimental insights on the deleterious effects of T1D on recovery from ischemic stroke. For reviews about molecular mechanisms of dysfunction after stroke associated with T2D models, the reader is directed to Ergul and colleagues (4,5). Furthermore, we emphasize findings from imaging studies that have generated new knowledge about the neural and vascular mechanisms that underlie poor functional outcome after stroke.…”

mentioning

confidence: 99%

Illuminating the Effects of Stroke on the Diabetic Brain: Insights From Imaging Neural and Vascular Networks in Experimental Animal Models

2016

View full text Add to dashboard Cite

Type 1 diabetes is known to cause circulatory problems in the eyes, heart, and limbs, and the brain is no exception. Because of the insidious effects of diabetes on brain circulation, patients with diabetes are two to four times more likely to have an ischemic stroke and are less likely to regain functions that are lost. To provide a more mechanistic understanding of this clinically significant problem, imaging studies have focused on how stroke affects neural and vascular networks in experimental models of type 1 diabetes. The emerging picture is that diabetes leads to maladaptive changes in the cerebrovascular system that ultimately limit neuronal rewiring and recovery of functions after stroke. At the cellular and systems level, diabetes is associated with abnormal cerebral blood flow in surviving brain regions and greater disruption of the blood-brain barrier. The abnormal vascular responses to stroke can be partly attributed to aberrant vascular endothelial growth factor (VEGF) signaling because genetic or pharmacological inhibition of VEGF signaling can mitigate vascular dysfunction and improve stroke recovery in diabetic animals. These experimental studies offer new insights and strategies for optimizing stroke recovery in diabetic populations.

show abstract

Cerebrovascular Complications of Diabetes: Focus on Stroke

Cited by 164 publications

References 107 publications

Surgical outcomes following encephaloduroarteriosynangiosis in adult moyamoya disease associated with Type 2 diabetes

Surgical outcomes following encephaloduroarteriosynangiosis in adult moyamoya disease associated with Type 2 diabetes

Cerebral Neovascularization in Diabetes: Implications for Stroke Recovery and beyond

Illuminating the Effects of Stroke on the Diabetic Brain: Insights From Imaging Neural and Vascular Networks in Experimental Animal Models

Contact Info

Product

Resources

About