Glucose Fluctuation and Severe Internal Carotid Artery Siphon Stenosis in Type 2 Diabetes Patients

Figures

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  Figure 1. Evaluated vessels comprising the intracranial arteries. Schematic of the intracranial arteries evaluated in this study. (A) (i) The A1 or A2 segment of the ACA, (ii) the C1 to C5 segment of intracranial ICA, (iii) the P1 or P2 segment of the PCA, and (iv) the M1 or M2 segment of the MCA. (B) Classification of intracranial ICA according to Fischer’s classification: C1, from the ACA branch to the PComA branch; C2, from the proximal PComA branch to the ophthalmic artery branch; C3, from the ophthalmic artery branch to the genu of the internal carotid artery; C4, in the cavernous sinus; and C5, from the proximal cavernous sinus to the orifice of the carotid canal. Abbreviations: ACA, anterior cerebral artery; ICA, internal carotid artery; MCA, middle cerebral artery; Oph.A, ophthalmic artery; PCA, posterior cerebral artery; PComA, posterior communicating artery.

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  Figure 2. Patient inclusion flow chart. Blood glucose fluctuations were measured via CGM for at least 7 days in all patients. Abbreviations: CGM, continuous glucose monitoring; MCI, mild cognitive impairment; MRI, magnetic resonance imaging; T2DM, type 2 diabetes mellitus.

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  Figure 3. A representative case of severe internal carotid artery siphon stenosis. (A) Magnetic resonance angiography (MRA) showing the severe stenosis in the left internal carotid artery siphon (arrow). (B,C) MRA source images showing 74% stenosis of the internal carotid artery (ICA) siphon evaluated using the WASID method, with the narrowest portion (B, between arrows; 1.0 mm) of the siphon ICA and the widest portion (C, between arrows; 3.8 mm) of the petrous ICA.

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  Figure 4. Scatter plots showing relationships between glucose fluctuation and internal carotid artery siphon stenosis. Glucose fluctuations assessed by standard deviation (SD) (A), coefficient of validation (%CV) (B), and mean amplitude of glycemic excursions (MAGE) (C) are significantly higher in the severe stenosis group than in the non-severe stenosis group (* p < 0.01).