The impact of glucose fluctuation on intracranial artery stenosis remains to be elucidated. This study aimed to investigate the association between glucose fluctuation and intracranial artery stenosis. This was a cross-sectional study of type 2 diabetes mellitus (T2DM) patients equipped with the FreeStyle Libre Pro continuous glucose monitoring system (Abbott Laboratories) between February 2019 and June 2020. Glucose fluctuation was evaluated according to the standard deviation (SD) of blood glucose, coefficient of variation (%CV), and mean amplitude of glycemic excursions (MAGE). Magnetic resonance angiography was used to evaluate the degree of intracranial artery stenosis. Of the 103 patients, 8 patients developed severe internal carotid artery (ICA) siphon stenosis (≥70%). SD, %CV, and MAGE were significantly higher in the severe stenosis group than in the non-severe stenosis group (<70%), whereas there was no significant intergroup difference in the mean blood glucose and HbA1c. Multivariable logistic regression analysis adjusted for sex showed that SD, %CV, and MAGE were independent factors associated with severe ICA siphon stenosis. In conclusion, glucose fluctuation is significantly associated with severe ICA siphon stenosis in T2DM patients. Thus, glucose fluctuation can be a target of preventive therapies for intracranial artery stenosis and ischemic stroke.

BACKGROUND: Synthetic magnetic resonance imaging (MRI) is an innovative MRI technology that enables the acquisition of multiple quantitative values, including T1 and T2 values, proton density, and myelin volume, in a single scan. Although the usefulness of myelin measurement with synthetic MRI has been reported for assessing several diseases, investigations in patients with stroke have not been reported. We aimed to explore the utility of myelin quantification using synthetic MRI in predicting outcomes in patients with acute ischemic stroke. METHODS: Patients with acute ischemic stroke (n=101) with a premorbid modified Rankin Scale score ≤2 were enrolled. We performed MRI with a 3 T scanner, acquiring synthetic MRI data in addition to data acquired using the routine protocol; we measured total myelin volume (TMV) using synthetic MRI software. After hospitalization, a synthetic MRI was performed when the patient’s condition was stable, with a median of 7 days from onset to MRI. We examined the factors related to good stroke outcomes (defined by a modified Rankin Scale score of ≤2 at 3 months). RESULTS: Patients with larger TMV were younger, were more frequently male, and had higher body mass index. In addition, TMV was associated with the severity of white matter hyperintensities and total small vessel burden scores. The patients with good outcomes (n=66) had larger TMVs than those without (144.85±22.19 versus 126.62±21.81 mL, P <0.001). Multivariable analysis revealed that the TMV quartiles were independently associated with good functional outcomes (odds ratio, 2.54 [95% CI, 1.12–6.70]; P =0.025) after adjusting for baseline clinical characteristics including initial stroke severity, acute brain infarct volume, and brain parenchymal volume. CONCLUSIONS: A large TMV quantified using synthetic MRI was independently associated with good functional outcomes after adjusting for several confounding factors. TMV, which suggests the validity of myelin quantification, might be a useful indicator for predicting stroke outcomes.

Periodontal disease is reportedly associated with an increased risk of stroke. Recent evidence suggests that periodontal disease aggravates cerebral small vessel disease (CSVD), including lacunar stroke. However, the periodontal pathogens associated with CSVD remain unclear. Thus, we examined the relationship between the relative rates of periodontal pathogens in the oral cavity and CSVD, to elucidate the effects of different types of periodontal pathogens on small cerebral vessels. Consecutive patients with acute ischemic stroke were prospectively enrolled. The associations between the relative rates of periodontal pathogens on tongue coating, background factors, and CSVD imaging findings were statistically analyzed. The relative rates of periodontal pathogens were calculated using quantitative polymerase chain reaction for six species of periodontal pathogens. Positivity for each periodontal pathogen was defined as the presence of more than the third quartile of the amount of each periodontal pathogen relative to the total amount of tongue-coating bacteria. A total of 347 patients with acute ischemic stroke (149 [42.9%] females, mean age 75.2±13.1 y) were registered. Positivity for Fusobacterium nucleatum was independently associated with high-grade white matter hyperintensities (odds ratio, 1.84; 95% confidence interval [CI], 1.10-3.08; p=0.021) and high-grade total CSVD score (odds ratio, 1.76; 95% CI, 1.04-2.96; p=0.035); however, the other five species did not show any association. The qualitative positivity for Fusobacterium nucleatum in the oral cavity was independently associated with high-grade white matter hyperintensities and high-grade total CSVD score in patients with ischemic stroke. Thus, oral care targeting Fusobacterium nucleatum may aid in impeding CSVD progression.

Introduction: The correlation between the composition of thrombi retrieved by mechanical thrombectomy (MT) and stroke etiology is inconclusive. We describe a case with atherosclerotic components in thrombi retrieved by MT for acute internal carotid artery (ICA) occlusion.Case Presentation: A 69-year-old man with acute onset of global aphasia and right hemiplegia was transferred to our institute. His baseline National Institutes of Health Stroke Scale score was 24. Magnetic resonance imaging demonstrated acute ischemic stroke in the left parietal lobe. Magnetic resonance angiography revealed occlusion of the left ICA. MT was attempted for acute left ICA occlusion. The initial angiography showed occlusion of the proximal ICA, while intraprocedural angiography revealed a large thrombus that extended from the cervical ICA to the intracranial ICA. Successful reperfusion was achieved by five passes using stent retrievers and an aspiration catheter. A large volume of red thrombus was retrieved by each pass. The final angiogram showed successful reperfusion with modified Thrombolysis in Cerebral Ischemia grade 2b and severe stenosis in the proximal ICA. Neck magnetic resonance imaging showed severe left ICA stenosis with a vulnerable plaque. Hence, his stroke etiology was determined as large artery atherosclerosis. Histopathological examination of the retrieved thrombi revealed atheromatous components, including cholesterol clefts, foam cells, and a necrotic core.Conclusions: Atherosclerotic components in retrieved thrombi might provide useful clues for diagnosing stroke pathogenesis. Further studies are warranted to clarify the utility of assessing atheromatous components in retrieved thrombi in diagnosing stroke etiology.