Glycosylated hemoglobin assesses the clinical value of intracranial artery stenosis severity

Xingyao LiAihua Fei^*

• Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China

Purpose: The aim of this study was to investigate the effect of glycosylated hemoglobin(HbA1c) on the severity of intracranial atherosclerosis (ICAS). Patients and Methods: We conducted a retrospective analysis of clinical data of patients who underwent intracranial digital subtraction angiography (DSA) and were admitted to Xinhua Hospital, Shanghai Jiao Tong University, between December 2021 and April 2023. Collected information included age, gender, blood lipid levels, and smoking status. Patients were stratified into two groups based on HbA1c levels: elevated HbA1c (≥6.5%) and normal HbA1c (<6.5%). With DSA, ICAS was classified into anterior and posterior circulation subgroups according to vascular anatomy. Stenosis severity was graded with the Warfarin-Aspirin Symptomatic Intracranial Disease (WASID) trial criteria: no/mild stenosis (0–49%), moderate stenosis (50–69%), severe stenosis (70–99%), and complete occlusion (100%). An ordinal multinomial regression analysis was employed to assess the association between HbA1c levels and ICAS severity. Results: A total of 360 participants were included in this study. The severity of ICAS worsened with higher HbA1c levels. Further subgroup analysis revealed that HbA1c levels of ≥6.5% were significantly and positively associated with anterior circulation stenosis (r = 0.13, P = 0.03) and showed a positive trend with posterior circulation stenosis (r = 0.13, P = 0.06). After adjusting for gender, age and smoking status, higher HbA1c levels were linked to an increased severity of stenosis in both the anterior and posterior circulations. Among blood lipid parameters, triglyceride levels demonstrated a significant correlation with ICAS severity (P < 0.05). Furthermore, subgroup analyses revealed that age over 68 years when HbA1c elevation was a risk factor for anterior circulation ICAS(OR 2.04, 95% CI 1.11-3.81,P<0.05), whereas age 68 years or under was a risk factor for posterior circulation ICAS. (OR 2.12, 95% CI 1.16–3.97,P<0.05). Conclusion: The severity of intracranial atherosclerotic stenosis (ICAS) was positively associated with an elevated HbA1c level (≥6.5%) . The association was more pronounced in the posterior circulation. Elevated triglyceride levels and age are also associated with ICAS progression. Keywords: Glycosylated hemoglobin;Intracranial atherosclerosis;Intracranial artery stenosis ;Digital subtraction angiography；diabetes