Diabetes and Stroke: Does an Excess Risk of Hemodynamic Cerebral Ischemia Exist?

BACKGROUND 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. METHODS Between 01/01/1990 and 30/06/2019, we revascularized 4117 carotid bifurcations in 3739 patients (2683 men and 1056 women; mean age: 71 (range: 28–97) years; 940 (25.1%) diabetics and 2799 (74.9%) nondiabetics). HCI was diagnosed clinically, under regional anesthesia, when a shunt needed to be inserted. RESULTS 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). CONCLUSIONS Diabetes was associated with increased HCI risk in our patients with carotid stenosis. This HCI-associated excess risk might explain, in part, stroke severity in diabetics and heightened surgical risk. It might be prevented by HCI detection and modification of therapeutic management.