Asymptomatic Carotid Stenosis is Associated with Gray and White Matter Damage

Avelar, Wagner Mauad; D’Abreu, Anelyssa; Coan, Ana Carolina; Lima, Fabrício Oliveira; Guimarães, Rachel; Yassuda, Clarissa L.; Oliveira, Germano P.; Guillaumon, Ana Terezinha; Filho, Augusto A.; Li, Min; Cendes, Fernando

doi:10.1111/ijs.12574

Cited by 24 publications

(25 citation statements)

References 35 publications

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“…A pilot study suggested, that altered cerebral perfusion in carotid stenosis is associated with regional cortical thinning [12]. Another study revealed a decrease of cortical thickness specifically in the anterior cerebral artery territory [13]. Several studies report an association of carotid artery stenosis with impaired cognitive performance [14–22].…”

Section: Introductionmentioning

confidence: 99%

Cortical thickness and cognitive performance in asymptomatic unilateral carotid artery stenosis

Nickel

Kessner

Niebuhr

et al. 2019

BMC Cardiovasc Disord

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Background We investigated changes of cortical thickness and its association with cognitive performance in patients with high-grade carotid artery stenosis without ischemic brain lesions. Methods We studied 25 patients with unilateral carotid artery stenosis ≥50% and 25 age-matched controls. All subjects underwent T1-weighted MRI, and cortical thickness was measured in 33 regions of interest in each hemisphere, as well as in brain regions belonging to the vascular territory of the middle cerebral artery (MCA). General linear mixed models were fitted to the dependent variable cortical thickness. Cognitive assessment comprised the Stroop Test and Trail Making Test B. Results In the linear mixed model, presence of carotid stenosis had no effect on cortical thickness. There was a significant interaction of stenosis and region with a trend towards lower cortical thickness in the MCA region on the side of carotid stenosis. Patients with carotid stenosis performed significantly worse on the Stroop test than controls, but there was no correlation with cortical thickness. Conclusion In patients with carotid stenosis without ischemic brain lesions, neither a clear pattern of reduced cortical thickness nor an association of cortical thickness with cognitive function was observed. Our data do not support the hypothesized association of cortical thinning and cognitive impairment in carotid stenosis. Electronic supplementary material The online version of this article (10.1186/s12872-019-1127-y) contains supplementary material, which is available to authorized users.

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Section: Introductionmentioning

confidence: 99%

Cortical thickness and cognitive performance in asymptomatic unilateral carotid artery stenosis

Nickel

Kessner

Niebuhr

et al. 2019

BMC Cardiovasc Disord

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“…Our major finding was that patients with ACS had significantly reduced bilateral thalamic volume, particularly in the medial dorsal thalamus. Previous studies have reported global gray matter atrophy in patients with ACS, 7 however, these studies did not investigate (or only marginally investigated) the relationship between subcortical nuclei and cognitive impairment. Consistent with previous, 19,20 the ACS patients in our cohort had a poorer cognitive performance in multiple cognitive domains compared to controls.…”

Section: Discussionmentioning

confidence: 95%

“…6 Previous studies using structural MRI have identified cortical atrophy in patients with ACS. 6,7 Similarly, the atrophy of subcortical nuclei including the thalamus, caudate, putamen, pallidum, hippocampus, amygdala, and nucleus accumbens was also reported in patients with Alzheimer's disease dementia. Moreover, in ACS patients, reduced cerebral blood flow 8 and decreased vascular reactivity 9 of the basal nuclei (caudate, pallidum and thalamus) were reported.…”

Section: Introductionmentioning

confidence: 92%

<p>Thalamic Atrophy Plays a Crucial Role in the Effect of Asymptomatic Carotid Stenosis on Cognitive Impairment</p>

Zhang

Qing

et al. 2020

CIA

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Purpose: Our objectives were to assess the abnormalities of subcortical nuclei by combining volume and shape analyses and potential association with cognitive impairment. Patients and Methods: Twenty-nine patients with severe ACS of the unilateral internal carotid artery and 31 controls were enrolled between January 2017 to August 2018. All participants underwent a comprehensive neuropsychological evaluation, blood lipid biochemical measurements, and structural magnetic resonance imaging (MRI) to measure subcortical volumes and sub-regional shape deformations. Basic statistics, correction for multiple comparisons. Seventeen ACS patients underwent carotid endarterectomy (CEA) within one week after baseline measurements, cognitive assessments and MRI scans were repeated 6 months after CEA. Results: The ACS patients had higher apolipoprotein B/apolipoprotein A1 (ApoB/ApoA1) ratio and worse performance in all cognitive domains than controls. Moreover, the ACS patients showed more profound thalamic atrophy assessed by shape and volume analysis, especially in the medial dorsal thalamus. No significant differences were found in other subcortical nuclei after multiple comparisons correction. At baseline, thalamic atrophy correlated with cognitive impairment and ApoB/ApoA1 ratio. Furthermore, mediation analysis at baseline showed that the association of carotid intima-media thickness with executive functioning was mediated by thalamic volume. After CEA, cognitive improvement and increase in the bilateral medial dorsal thalamic volume were observed. Conclusion: Our study identified the distinct atrophy of subcortical nuclei and their association with cognition in patients with ACS. Assessments of the thalamus by volumetric and shape analysis may provide an early marker for cerebral ischemia and reperfusion after CEA.

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“…In the classical, instantaneous BCCAo model of chronic cerebral hypoperfusion, the irreversible disruption of the white matter and myelin degradation has been suggested to be responsible for cognitive dysfunction that is correlated with the myelin changes [ 11 , 61 ]. In humans, while the carotid stenosis-related atrophy was lateralized to the side of the stenosis [ 79 ], the white matter disintegration, as measured by diffusion tensor imaging, was found more extensively [ 80 ]. Furthermore, the parallel dynamic changes in cognitive function and in the white matter diffusion parameters after endarterectomy propose white matter microstructural measures as a potential biomarker [ 81 ].…”

Section: Discussionmentioning

confidence: 99%

Stepwise occlusion of the carotid arteries of the rat: MRI assessment of the effect of donepezil and hypoperfusion-induced brain atrophy and white matter microstructural changes

Nyitrai

Spisák

et al. 2018

PLoS ONE

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Bilateral common carotid artery occlusion (BCCAo) in the rat is a widely used animal model of vascular dementia and a valuable tool for preclinical pharmacological drug testing, although the varying degrees of acute focal ischemic lesions it induces could interfere with its translational value. Recently, a modification to the BCCAo model, the stepwise occlusion of the two carotid arteries, has been introduced. To acquire objective translatable measures, we used longitudinal multimodal magnetic resonance imaging (MRI) to assess the effects of semi-chronic (8 days) donepezil treatment in this model, with half of the Wistar rats receiving the treatment one week after the stepwise BCCAo. With an ultrahigh field MRI, we measured high-resolution anatomy, diffusion tensor imaging, cerebral blood flow measurements and functional MRI in response to whisker stimulation, to evaluate both the structural and functional effects of the donepezil treatment and stepwise BCCAo up to 5 weeks post-occlusion. While no large ischemic lesions were detected, atrophy in the striatum and in the neocortex, along with widespread white matter microstructural changes, were found. Donepezil ameliorated the transient drop in the somatosensory BOLD response in distant cortical areas, as detected 2 weeks after the occlusion but the drug had no effect on the long term structural changes. Our results demonstrate a measurable functional MRI effect of the donepezil treatment and the importance of diffusion MRI and voxel based morphometry (VBM) analysis in the translational evaluation of the rat BCCAo model.

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Asymptomatic Carotid Stenosis is Associated with Gray and White Matter Damage

Cited by 24 publications

References 35 publications

Cortical thickness and cognitive performance in asymptomatic unilateral carotid artery stenosis

Cortical thickness and cognitive performance in asymptomatic unilateral carotid artery stenosis

<p>Thalamic Atrophy Plays a Crucial Role in the Effect of Asymptomatic Carotid Stenosis on Cognitive Impairment</p>

Stepwise occlusion of the carotid arteries of the rat: MRI assessment of the effect of donepezil and hypoperfusion-induced brain atrophy and white matter microstructural changes

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