Extracranial Artery Stenosis Is Associated With Total MRI Burden o Cerebral Small Vessel Disease in lschemic Stroke Patients of Suspected Small or Large Artery Origins
Extracranial Artery Stenosis Is Associated With Total MRI Burden o Cerebral Small Vessel Disease in lschemic Stroke Patients of Suspected Small or Large Artery Origins
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颅外动脉狭窄与疑似小动脉或大动脉起源的缺血性中风患者的脑小血管疾病的总 MRI 负担相关
DOI：
10.3389/fneur.2019.00243
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发表时间：
2019-03-21
影响因子：
3.4
通讯作者：
Zeng, Jinsheng
中科院分区：
文献类型：
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作者：
Lu, Tao;Liang, Jiahui;Zeng, Jinsheng
背景和目的：颅外动脉狭窄（ECAS）与脑小血管病（cSVD）的个体影像学标志物相关。然而，关于ECAS与通过磁共振成像（MRI）评估的cSVD总负荷之间的相关性报道甚少。本研究的目的是探讨ECAS和cSVD负担之间的关系，在怀疑小或大动脉origin.Methods缺血性中风患者：我们回顾了连续的怀疑小或大动脉起源的缺血性中风患者进行彩色多普勒超声检查和脑MRI。采用彩色多普勒超声检查双侧颅外脑动脉，包括颈总动脉、颈内动脉（伊卡）和椎动脉近端（VA、开口、V2-3段）。ECAS严重程度分为无/轻度狭窄、中度狭窄、重度狭窄或闭塞。根据使用MRI确定的每种cSVD标志物的负荷（腔隙性梗死、白色高信号、脑微出血和血管周围间隙扩大），通过给予1分来评估cSVD总评分。结果：221例患者纳入本研究（平均年龄61 ± 12岁，75.6%为男性）。高血压、当前吸烟、糖尿病和糖尿病在患者中常见（分别为67.4%、45.7%、43.9%和36.7%），而其他血管风险因素（包括既往卒中或TIA和过量饮酒）的发生率较低（分别为19.0%和15.4%）。总cSVD负荷较高的患者年龄明显较大，ECAS发生率较高。在总cSVD负荷较高的患者中，高血压的频率显著较高。这一分析表明，日益严重的ECAS（从无狭窄到100%）与调整其他血管风险因素后总cSVD评分增加独立相关（比值比1.76，95% CI [1.16-2.69]）。在本研究中，在疑似小动脉或大动脉起源的缺血性卒中患者中，超声证据显示的高水平ECAS与共存的晚期脑cSVD相关。需要进一步的研究来确定颅外动脉成像是否以及如何帮助减少cSVD负担或改善认知功能。
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.