Extracranial Artery Stenosis Is Associated With Total MRI Burden of Cerebral Small Vessel Disease in Ischemic Stroke Patients of Suspected Small or Large Artery Origins

Abstract

Background and Purpose: Extracranial artery stenosis (ECAS) is related to individual imaging markers of cerebral small vessel disease (cSVD). However, little has been reported on the association between ECAS and the total burden of cSVD as assessed by magnetic resonance imaging (MRI). The purpose of this study was to investigate the relationship between ECAS and cSVD burden in patients with ischemic stroke of suspected small or large artery origin. Methods: We reviewed consecutive patients with ischemic stroke of suspected small or large artery origin who underwent color Doppler ultrasonography and brain MRI. Bilateral extracranial cerebral arteries including common carotid artery, internal carotid artery (ICA), and proximal vertebral artery (VA, ostium, V2–3 segments) were assessed using color Doppler ultrasonography. ECAS severity was classified as no/mild stenosis, moderate stenosis, severe stenosis, or occlusion. The total cSVD score was assessed by awarding one point according to the load of each of these cSVD markers as determined using MRI; lacunar infarction, white matter hyperintensities, cerebral microbleeds, and enlarged perivascular spaces. The relationship between ECAS severity and cSVD burden according to MRI was examined. Results: Two hundred and twenty one patients were included in this study (mean age 61 ± 12 years, 75.6% male). Hypertension, current smoking, hyperlipidaemia, and diabetic mellitus were frequent among the patients (67.4, 45.7, 43.9, and 36.7%, respectively), while the other vascular risk factors including previous stroke or TIA and alcohol excess were less frequent (19.0 and 15.4%, respectively). Patients with higher total cSVD burden was significantly older and had severer ECAS. The frequency of hypertension was significantly higher in patients with higher total cSVD burden. This analysis indicated that that increasing ECAS severity (from no stenosis through to 100%) was independently associated with increasing total cSVD score after adjusting for other vascular risk factors (odds ratio 1.76, 95% CI [1.16–2.69]). Conclusions: In this study, high levels of ECAS from ultrasound evidence were associated with coexisting advanced cerebral cSVD in ischemic stroke patients of suspected small or large artery origin. Further studies are required to determine if and how extracranial arterial imaging helps reduce cSVD burden or improves cognitive function.

Association between Intracranial Arterial Dolichoectasia and Cerebral Small Vessel Disease and Its Underlying Mechanisms

“…Therefore, an understanding of the correlation between large vessel changes and CSVD as well as the underlying mechanisms will be of great significance for the prevention and treatment of cerebrovascular disease. 16 The non-parallelism in cerebral large-and small-vessel changes suggests that the assessment of pathological changes in the artery wall should not be limited to atherosclerosis, but should also include functional features such as vascular elasticity and compliance. 17 The hemodynamic characteristics of IADE are consistent with the changes in arterial elasticity and compliance.…”

“…For example, some severe CSVD cases with several vascular risk factors were discovered with normal large artery structures on magnetic resonance artery (MRA) or computed tomographic angiography. Therefore, an understanding of the correlation between large vessel changes and CSVD as well as the underlying mechanisms will be of great significance for the prevention and treatment of cerebrovascular disease [ 16 ]. The non-parallelism in cerebral large- and small-vessel changes suggests that the assessment of pathological changes in the artery wall should not be limited to atherosclerosis, but should also include functional features such as vascular elasticity and compliance [ 17 ].…”

Prediction for the Total MRI Burden of Cerebral Small Vessel Disease With Retinal Microvascular Abnormalities in Ischemic Stroke/TIA Patients

“…Participants underwent an assessment of cerebrovascular risk factors during the course of the study according to a previous study (15). Systolic blood pressure ≥140 mmHg, diastolic blood pressure ≥90 mmHg, or the combination of self-reported hypertension diagnosis and use of antihypertensive medications at the time of examination was identified as hypertension.…”

Potential Mechanism of Venous System for Leukoaraiosis: From post-mortem to in vivo Research

“…Extracranial artery stenosis has been reported to be related to CSVD [43]. Regarding the extracranial venous system, Zivadinov et al [32] systematically reviewed the extracranial venous system abnormalities and CNS diseases, in which extracranial venous abnormalities were separated into structural/morphological abnormalities, haemodynamic/functional abnormalities, and those determined only by the composite criteria and use of multimodal imaging.…”