Carotid Arterial Hemodynamic in Ischemic Levkoaraiosis Suggests Hypoperfusion Mechanism

Abstract

Background: Leukoaraiosis (ILA) is believed to be ischaemic in origin due to its similar location as that of lacunar infarctions and its association with cerebrovascular risk factors. However, its pathophysiology is not well understood. The ischaemic injuries may be a result of increased pulsatility or cerebral hypo-perfusion. We used carotid duplex ultrasound to prove that the underlying mechanism is hypo-perfusion. Methods: We compared 55 ILA patients to 44 risk factor-matched controls with normal magnetic resonance imaging (MRI) of the head. ILA diagnosis was based on MRI and was further categorised according to the Fazekas scale. We measured carotid artery blood flow velocity and diameter and calculated carotid blood flow and resistance indexes. Results: Blood flow velocities and blood flows were significantly lower in the ILA group, including diastolic, systolic and mean pressures (p ≤ 0.05). The resistance indices were higher in the ILA group, but the differences were not statistically significant. All the velocities and blood flows showed a decreasing trend with higher Fazekas score, whereas resistance indexes showed an increasing trend. Conclusions: Lower blood flow and higher resistance of carotid arteries are consistent with the hypo-perfusion theory of ILA. Carotid ultrasound could have a diagnostic and prognostic role in ILA patients.

Ratio between carotid artery stiffness and blood flow – a new ultrasound index of ischemic leukoaraiosis

“…ILAi were therefore defined as the ratios between carotid stiffness parameters (PWVβ, Ep, β index) and blood flows in the ICA: Q-ICAd and Q-ICAm. 22 , 23 All the ILAi were higher in the ILA group compared to the control group ( P <0.01), the most significant was PWVβ/Q-ICAd ( P =0.001). The results are shown in Table 2 .…”

“…The study was a post hoc analysis of our previous studies on carotid stiffness parameters and carotid hemodynamic in patients with ILA. 22 , 23 The subjects were included in the study based on the already performed brain magnetic resonance imaging (MRI). The patients with ILA were chosen among patients who have been treated in our outpatient clinic because of ILA and were up to 65 years old.…”

“…In our previously published studies, we found increased carotid stiffness and diminished flow through the ICAs in patients with ILA compared to CVD risk factor-matched controls. 22 , 23 The combination of stiff large arteries with loss of the Windkessel effect and lower cerebral blood flow (CBF) could synergically cause insufficient diastolic perfusion in the deep white matter region and cause ILA. In this case, the ratio between local carotid stiffness parameters and CBF could be used as a diagnostic index of ILA.…”

Laterality of Attentional Networks in Patients With Cerebral Small Vessel Disease

“…Among many risk factors for CSVD, age and hypertension are the clearest risk factors. The incidence of WMHs increases with age, with an average age of 10 years and an increase of two to three times (Turk et al, 2015). Meanwhile, studies have found that the detection rate of LI at 60 years old is 6% to 7%, while the detection rate at 80 years old is increased to 28% (Vermeer et al, 2007).…”

Ligustrazine suppresses neuron apoptosis via the Bax/Bcl‐2 and caspase‐3 pathway in PC12 cells and in rats with vascular dementia

“…Current understanding of the CCH pathophysiology indicates that it is a disease defined by cerebral blood vessel infarction or angiostenosis, which causes an insufficient supply of glucose and oxygen to the central nervous system, leading to neuronal damage in the center and surrounding penumbra with a milder ischemic insult . The most recent research has shown that neuronal injury, induced by oxygen and glucose deprivation (OGD), is a very complex process with multiple mechanisms, including excitotoxicity, oxidative stress, apoptosis, and variations in gene expression or kinase activation . Given the close relationship between them, increasing attention has been focused on elucidating the underlying mechanism of CCH‐VD progression to provide promising therapeutic approaches.…”