Association between leukoaraiosis and cerebral blood flow territory alteration in asymptomatic internal carotid artery stenosis

Chen, Ya-Fang; Kuo, Ying-Shiung; Wei, Wenxin; Tang, Sung‐Chun; Jiang, Shu-Fen

doi:10.1016/j.crad.2017.12.006

Cited by 8 publications

(7 citation statements)

References 20 publications

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“…An insufficient blood supply due to vascular pathology is thought to be the most important cause of WMHs. Hypoperfusion has been linked with the severity of white matter damage in large samples of individuals (Shi et al, 2016;van Dalen et al, 2016;Chen et al, 2017Chen et al, , 2018Liu et al, 2018). Low perfusion in normal-appearing white matter (NAWM) has also been associated with subsequent WMH development, and areas of impaired cerebral vascular reactivity (CVR) precede the progression from NAWM to WMH (Sam et al, 2016;Rane et al, 2018), all of which support the role of chronic hemodynamic impairment in the pathogenesis and progression of WMHs.…”

Section: Discussionmentioning

confidence: 97%

The Asymmetry of White Matter Hyperintensity Burden Between Hemispheres Is Associated With Intracranial Atherosclerotic Plaque Enhancement Grade

Zhou

Qing

et al. 2020

Front. Aging Neurosci.

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The contribution of intracranial atherosclerotic stenosis (ICAS) to the development of white matter hyperintensities (WMHs) has not been fully elucidated. We aimed to retrospectively assess the relationship between WMH burden and unilateral ICAS by combined examination of lumen stenosis, plaque enhancement, and cerebral perfusion. Materials and methods: A cross-sectional study of 41 patients with symptomatic unilateral ICAS (mean age 57 ± 10 years; 26 males) was conducted. Detailed clinical data, including vascular risk factors, were obtained. WMH volume was derived from 3D-fluid-attenuated inversion recovery (3D-FLAIR) and was assessed by using a validated semi-automated protocol. Lumen stenosis, plaque enhancement, and cerebral perfusion (assessed on time-to-peak parameter using the Alberta Stroke Program Early CT score (TTP-ASPECTS) scale) were evaluated. The WMH volumes of peri-ventricular (PWMH) and deep (DWMH) white matter were calculated separately and compared between hemispheres. Associations between WMH volume (inter-hemispheric volume difference, ipsilateral and contralateral to the ICAS site separately), unilateral ICAS imaging metrics, and vascular risk factors were assessed by using linear regression. Results: The DWMH volume ipsilateral to the ICAS site (ipsilateral DWMH volume) was significantly greater than that of the contralateral site (P < 0.001), while the PWMH volume difference between hemispheres did not reach statistical significance. The interhemispheric DWMH volume difference was significantly associated with a higher plaque enhancement grade (β = 0.436, P = 0.005) and inversely associated with cerebral hypoperfusion (lower TTP-ASPECTS) (β = −0.613, P < 0.001). In the between-subject multivariable regression analysis, while older age (β = 0.323, P = 0.025), hypoperfusion (β = −0.394, P = 0.007), and hypertension (β = 0.378, P = 0.011) were independently associated with ipsilateral DWMH volume, plaque enhancement did not show an

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Section: Discussionmentioning

confidence: 97%

The Asymmetry of White Matter Hyperintensity Burden Between Hemispheres Is Associated With Intracranial Atherosclerotic Plaque Enhancement Grade

Zhou

Qing

et al. 2020

Front. Aging Neurosci.

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“…( 2017 ) and Chen et al. ( 2018 ) reported that WMHs increased with decrements in the local cerebral blood flow. Fang et al.…”

Section: Discussionmentioning

confidence: 97%

White matter hyperintensities had a correlation with the cerebral perfusion level, but no correlation with the severity of large vessel stenosis in the anterior circulation

et al. 2023

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Objective The contribution of large vessel stenosis to the development of white matter hyperintensities (WMHs) has not been fully elucidated. This study aims to explore the correlation between ipsilateral white matter hyperintensities (WMHs) and the severity of large vessel stenosis in the anterior circulation and cerebral perfusion level, as well as analyze the factors influencing WMHs. Methods A cross‐sectional study of 150 patients with unilateral anterior circulation large vessel stenosis of ≥50% was conducted. The severity of ipsilateral WMHs was assessed by Fazekas scale on T2‐weighted image and/or fluid‐attenuated inversion recovery MR imaging, vascular stenosis severity was evaluated on computed tomography angiography images, and the level of cerebral perfusion was rated according to a staging system for abnormal cerebral perfusion based on CTP results. The relationships between the stenosis severity, cerebral perfusion level and ipsilateral WMHs severity were analyzed. A multivariate logistic regression analysis was performed to determine the factors independently influencing WMHs. Results Among 150 patients (mean age, 63.12 ± 10.55 years), there was a statistically significant positive correlation between cerebral perfusion level and the severity of DWMHs and PWMHs (Gamma = 0.561, p < .001; Gamma = 0.600, p < .001), and a positive correlation between cerebral perfusion level and the severity of vascular stenosis (Gamma = 0.495, p < .001).While, there was no statistically significant correlation between the severity of vascular stenosis and the severity of DWMHs and PWMHs (Gamma = 0.188, p = .08; Gamma = 0.196, p = .06). The multivariate logistic regression analysis results demonstrated that age (OR = 1.047, 95% CI 1.003–1.093; p = .035), stroke/TIA history (OR = 2.880, 95% CI 1.154–7.190; p = .023) and stage II of cerebral perfusion (OR = 2.880, 95% CI 1.154–7.190; p = .023) were independent influencing factors on ipsilateral DWMHs. Age (OR = 1.051, 95% CI 1.009–1.094; p = .018), and stage II of cerebral perfusion (OR = 12.871, 95% CI 3.576‐46.322; p < .001) were factors independently influencing ipsilateral PWMHs. Conclusion White matter hyperintensities may be attributed to cerebral hypoperfusion secondary to vascular stenosis but not directly to the severity of stenosis in the large vessels of anterior circulation. Moreover, longitudinal studies with sequential imaging exams may further reveal the impact of cerebral perfusion secondary to vascular stenosis on the development and progression of WMHs.

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“…In the presence of a failure of the collateral vessels system, blood flow derangement occurs and it can induce a worsening of cerebral functions, including cognitive activities. Moreover, the efficiency of collateral vessels can progressively deteriorate thus exposing cerebral regions supported by collateral circulation to a higher risk of developing hypoperfusion and cerebral ischemic damages or dysfunctions (35).…”

Section: Possible Pathogenetic Mechanismsmentioning

confidence: 99%

“…The Rotterdam study showed that lower cognitive scores characterized patients with major impact of WMLs (45). WMLs are particularly associated with carotid stenosis and tend to progressively increase (35) . From a pathological point of view, WMLs and silent infarcts may be considered as a continuum.…”

Section: Possible Pathogenetic Mechanismsmentioning

confidence: 99%

Impact of carotid stenosis on cerebral hemodynamic failure and cognitive impairment progression: a narrative review

Viticchi¹,

Falsetti²,

Potente³

et al. 2021

Ann Transl Med

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Carotid atherosclerosis has a relevant impact on cerebral blood flow regulation. There is accruing evidence that hemodynamic impairment related to the presence of a significant carotid lumen narrowing may predispose to the development of cerebral dysfunctions, including a reduction in cognitive abilities. In the last years an increasing number of findings showed that carotid stenosis did contribute to cognitive impairment not only in relation to the occurrence of cerebral ischemic lesions, but also as an independent risk factor. The principal mechanisms involved are chronic hypoperfusion, microembolization and cerebrovascular reactivity impairment. Moreover, more recent studies showed alterations of regional functional connectivity. In this narrative review, we analyzed the relationships between carotid stenosis, cerebral hemodynamic derangement and cognitive impairment onset and progression, and underlined that cognitive impairment is the final result of the complex interaction between different elements, including also collateral circulation, cerebral hemodynamic status, brain connectivity and pro-inflammatory state. Further, therapeutic approaches, with a specific focus on vascular risk factors correction and on the effectiveness of surgical or endovascular interventions were discussed. We particularly focused our attention on the concept of "asymptomatic carotid stenosis", and how could a cognitive impairment improve after an intervention, and how this could change the indications to surgical approach. Larger studies and randomized controlled trials are urgently required to better define time, characteristics and effectiveness of both medical and surgical/ endovascular approaches.

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Association between leukoaraiosis and cerebral blood flow territory alteration in asymptomatic internal carotid artery stenosis

Cited by 8 publications

References 20 publications

The Asymmetry of White Matter Hyperintensity Burden Between Hemispheres Is Associated With Intracranial Atherosclerotic Plaque Enhancement Grade

The Asymmetry of White Matter Hyperintensity Burden Between Hemispheres Is Associated With Intracranial Atherosclerotic Plaque Enhancement Grade

White matter hyperintensities had a correlation with the cerebral perfusion level, but no correlation with the severity of large vessel stenosis in the anterior circulation

Impact of carotid stenosis on cerebral hemodynamic failure and cognitive impairment progression: a narrative review

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