Increased tortuosity of bilateral distal internal carotid artery is associated with white matter hyperintensities

Abstract

Background Although the pathophysiology of white matter hyperintensities remains unclear, we can recently explore the possible relationship with white matter hyperintensities by using quantitative parameter. Purpose To demonstrate the relationship between bilateral distal internal carotid arterial tortuosity and total brain white matter hyperintensities volume in elderly individuals. Material and Methods A total of 345 patients (age > 65 years) with brain magnetic resonance (MR) examinations were retrospectively included (44.1% men; mean age = 72.1 ± 6.25 years; 55.9% ≥ 70 years). We measured the Tortuosity Index (TI) of the bilateral distal internal carotid artery and basilar artery on MR angiography imaging, and white matter hyperintensities volume on fluid-attenuated inversion recovery MR sequence. Multiple linear regression was used to assess the association of the TI with quantitatively derived brain white matter hyperintensity volume, after adjusting for demographics (age, sex), vascular risk factors (hypertension, diabetes, heart disease), and vessel diameters, total intracranial volume (TIV). Results Increased tortuosity of bilateral distal internal carotid artery was associated with greater burden of white matter hyperintensity volume (right: β = 11.223, P = 0.016; left: β = 20.701, P < 0.001). This relationship was independent of age and hypertension, both of which have been considered the strongest risk factors for white matter hyperintensities. Conclusion Our results suggest that tortuosity of the bilateral distal internal carotid artery is associated with white matter hyperintensities, independent of age and hypertension.

Effect of Blood Transfusion on Cerebral Hemodynamics and Vascular Topology Described by Computational Fluid Dynamics in Sickle Cell Disease Patients.

“…Thus, based on the CFD TAMV and the WSS levels, both these participants were at increased risk for stroke as previously described [7; 36; 47]. While Liu et al found that large vessel vasculopathy was associated with increased white matter disease in adults with SCD [48], our study demonstrates that cerebrovascular events occur in children with SCD with even mild large vessel vasculopathy, suggesting additional pathophysiologic mechanisms which contribute to cerebrovascular events. Certainly, large vessel vasculopathy contributes to the development of silent infarcts as well as overt cerebrovascular disease, as Guilliams et al found a greater distribution and overall density of silent cerebral infarcts in areas with large vessel vasculopathy [49].…”

Arterial Tortuosity and Its Correlation with White Matter Hyperintensities in Acute Ischemic Stroke

“…The prevalence of carotid artery kinking was significantly higher in WMHs patients, and kinking may be a risk factor of WMHs [ 18 , 43 ]. Moreover, recent studies established an association between WMHs and arterial tortuosity which was evaluated using the tortuosity index [ 17 , 44 ]. However, these studies excluded the patients with stroke and only concerned internal carotid arteries tortuosity.…”

“…Arterial tortuosity causes WMHs through various possible mechanisms. First, increased arterial tortuosity promotes hemodynamic variation in cerebral blood flow which can result in hypoperfusion and chronic brain ischemia and then may increase the risk of developing WMHs [ 17 , 43 ]. Second, the microembolism may be another mechanism.…”

“…Other risk factors including diabetes mellitus, genetic factors, and homocysteine are also identified [ 14 – 16 ]. Some studies indicated arterial tortuosity may be associated with an increased risk of WMHs in elderly population [ 17 , 18 ]. However, another research suggest that it is brain vessel density, but not vessel tortuosity, that is related to WMH lesions in young adults [ 19 ].…”

Complex vascular anatomy is a predictor of silent cerebral ischemia after carotid artery stenting

“…First of all, the presence of complex aortic arch anatomy may cause an increased risk of neurological complications [2][3][4]. Difficulty of cannulation that can be attributed to technical problems related with anatomical factors is associated with subclinical ischemic events.…”