Atherosclerosis

2019

DOI: 10.1016/j.atherosclerosis.2019.04.230

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Progression of brain white matter hyperintensities in asymptomatic patients with carotid atherosclerotic plaques and no indication for revascularization

Enrico Ammirati

¹

,

Francesco Moroni

²

,

³

et al.

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I S C L a I M E R : T H E M A N U S C R I P T A N D I T S C O N T E N T S A R E C O N F I D E N T I A L I N T E N D E D F O R J1

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Cited by 16 publications

(19 citation statements)

References 44 publications

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“…Our results were consistent with some previous studies evaluating the effects of carotid IPH on certain CSVD markers such as WMHs, lacunes, and CMBs (13)(14)(15). Certainly, our study also partly conflicted some studies that did not detect the association between carotid IPH and WMHs or lacunes (9)(10)(11)(12). For example, the study by Ammirati et al (11) examined the association between the progression of WMHs and plaque characteristics by using carotid ultrasound in asymptomatic patients with <70% stenosis, and they reached negative results.…”

Section: Discussionsupporting

confidence: 91%

Cerebral Small Vessel Disease Burden Related to Carotid Intraplaque Hemorrhage Serves as an Imaging Marker for Clinical Symptoms in Carotid Stenosis

¹

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²

,

³

et al. 2021

Front. Neurol.

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Objectives: In patients with carotid stenosis, to investigate the relationship between carotid intraplaque hemorrhage (IPH) and total burden of cerebral small vessel disease (CSVD) and preliminarily explore whether the total CSVD burden as an imaging marker can distinguish the severity of clinical symptoms.Methods: A total of 108 patients (the mean age was 66 ± 7 years, and 85.2% were male) with unilateral carotid stenosis ≥50% underwent brain MRI and high-resolution MRI for carotid plaque characterization. The total burden of CSVD was calculated by accumulating one point according to the presence or severity of each of the four MRI markers: white matter hyperintensities, lacunes, perivascular spaces, and cerebral microbleeds. Recent clinical symptoms including transient ischemic attack, amaurosis fugax, and ischemic stroke were recorded. The association between intraplaque hemorrhage (IPH) and total CSVD burden was examined adjusted for other risk factors. The symmetry of CSVD burdens between the ipsilateral and contralateral hemispheres of IPH was tested. Imaging features (CSVD score, IPH, degree of stenosis, and completeness of the circle of Willis) were correlated with clinical symptoms by Kruskal–Wallis H test, Chi-square test, and Fisher's exact test.Results: Multivariable logistic regression analysis showed that IPH (OR = 2.98, 95% CI [1.39, 6.40], p = 0.005) was independently associated with a higher CSVD score. The presence of unilateral IPH was associated with the inter-hemispheric CSVD score difference (p = 0.004). Patients with stroke had a higher ipsilateral CSVD score than asymptomatic patients (p = 0.004) and those with transient ischemic attack/amaurosis fugax (p = 0.008). The statistical difference was marginally significant between symptoms and IPH (p = 0.057). No statistical difference was found between the symptoms and degree of stenosis and the completeness of the circle of Willis (p > 0.05).Conclusions: Carotid IPH is associated with an elevated total burden of CSVD in patients with carotid stenosis. Compared with the degree of stenosis, primary collaterals, and IPH, the total CSVD score might be a more effective imaging marker linked with clinical symptoms.

“…Our results were consistent with some previous studies evaluating the effects of carotid IPH on certain CSVD markers such as WMHs, lacunes, and CMBs (13)(14)(15). Certainly, our study also partly conflicted some studies that did not detect the association between carotid IPH and WMHs or lacunes (9)(10)(11)(12). For example, the study by Ammirati et al (11) examined the association between the progression of WMHs and plaque characteristics by using carotid ultrasound in asymptomatic patients with <70% stenosis, and they reached negative results.…”

Section: Discussionsupporting

confidence: 91%

Cerebral Small Vessel Disease Burden Related to Carotid Intraplaque Hemorrhage Serves as an Imaging Marker for Clinical Symptoms in Carotid Stenosis

¹

,

²

,

³

et al. 2021

Front. Neurol.

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Objectives: In patients with carotid stenosis, to investigate the relationship between carotid intraplaque hemorrhage (IPH) and total burden of cerebral small vessel disease (CSVD) and preliminarily explore whether the total CSVD burden as an imaging marker can distinguish the severity of clinical symptoms.Methods: A total of 108 patients (the mean age was 66 ± 7 years, and 85.2% were male) with unilateral carotid stenosis ≥50% underwent brain MRI and high-resolution MRI for carotid plaque characterization. The total burden of CSVD was calculated by accumulating one point according to the presence or severity of each of the four MRI markers: white matter hyperintensities, lacunes, perivascular spaces, and cerebral microbleeds. Recent clinical symptoms including transient ischemic attack, amaurosis fugax, and ischemic stroke were recorded. The association between intraplaque hemorrhage (IPH) and total CSVD burden was examined adjusted for other risk factors. The symmetry of CSVD burdens between the ipsilateral and contralateral hemispheres of IPH was tested. Imaging features (CSVD score, IPH, degree of stenosis, and completeness of the circle of Willis) were correlated with clinical symptoms by Kruskal–Wallis H test, Chi-square test, and Fisher's exact test.Results: Multivariable logistic regression analysis showed that IPH (OR = 2.98, 95% CI [1.39, 6.40], p = 0.005) was independently associated with a higher CSVD score. The presence of unilateral IPH was associated with the inter-hemispheric CSVD score difference (p = 0.004). Patients with stroke had a higher ipsilateral CSVD score than asymptomatic patients (p = 0.004) and those with transient ischemic attack/amaurosis fugax (p = 0.008). The statistical difference was marginally significant between symptoms and IPH (p = 0.057). No statistical difference was found between the symptoms and degree of stenosis and the completeness of the circle of Willis (p > 0.05).Conclusions: Carotid IPH is associated with an elevated total burden of CSVD in patients with carotid stenosis. Compared with the degree of stenosis, primary collaterals, and IPH, the total CSVD score might be a more effective imaging marker linked with clinical symptoms.

“…However, vascular risk factors may be the confounding variables underlying the observed associations (8). In a recent publication by our group, carotid plaque features were not associated to WMH progression in asymptomatic subjects at intermediate-high cardiovascular risk with non-critical carotid stenosis at 20 month follow up (81). The relationship between CMD and carotid atherosclerosis has been less investigated.…”

Section: I S C L a I M E R : T H E M A N U S C R I P T A N D I T S C O N T E N T S A R E C O N F I D E N T I A L I N T E N D E D F O R Jmentioning

confidence: 83%

Association of White Matter Hyperintensities and Cardiovascular Disease

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²

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³

et al. 2020

Circ: Cardiovascular Imaging

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Cardiac and cerebrovascular diseases are currently the leading causes of mortality and disability worldwide. Both the heart and brain display similar vascular anatomy, with large conduit arteries running on the surface of the organ providing tissue perfusion through an intricate network of penetrating small vessels. Both organs rely on fine tuning of local blood flow to match metabolic demand. Blood flow regulation requires adequate functioning of the microcirculation in both organs, with loss of microvascular function, termed small vessel disease (SVD) underlying different potential clinical manifestations. SVD in the heart, known as coronary microvascular dysfunction, can cause chronic or acute myocardial ischemia and may lead to development of heart failure. In the brain, cerebral SVD can cause an acute stroke syndrome known as lacunar stroke or more subtle pathological alterations of the brain parenchyma, which may eventually lead to neurological deficits or cognitive decline in the long term. Coronary microcirculation cannot be visualized in vivo in humans, and functional information can be deduced by measuring the coronary flow reserve. The diagnosis of cerebral SVD is largely based on brain magnetic resonance imaging, with white matter hyperintensities, microbleeds, and brain atrophy reflecting key structural changes. There is evidence that such structural changes reflect underlying cerebral SVD. Here, we review interactions between SVD and cardiovascular risk factors, and we discuss the evidence linking cerebral SVD with large vessel atheroma, atrial fibrillation, heart failure, and heart valve disease.

“…The study population consists of the baseline cohort of a prospective study to assess carotid artery plaque features in relation with subclinical cerebral damage (Imaging della PLAcca Carotidea, IMPLAC study, ClinicalTrials.gov registration number NCT03333330 and EudraCT number 2012-000648-83) [21] . The study was approved by the Ethics Committee of the San Raffaele Hospital (date of approval January 30th, 2012, protocol name IMPLAC).…”

Section: Methodsmentioning

confidence: 99%

Extent and characteristics of carotid plaques and brain parenchymal loss in asymptomatic patients with no indication for revascularization

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²

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³

et al. 2020

IJC Heart & Vasculature

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Highlights Age and fibrocalcific carotid plaques are associated with lower total brain volume. Fibrocalcific carotid plaques are associated with lower gray matter volumes. White matter volumes are associated with the extent of carotid atherosclerosis. Grey and white matter likely have differential susceptibility to processes.

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