White matter hyperintensity determines ischemic stroke severity in symptomatic carotid artery stenosis

Song, Joomee; Kim, Keon-Ha; Jeon, Pyoung; Kim, Young‐Wook; Kim, Dong Ik; Park, Yang-Jin; Park, Moo‐Seok; Chung, Jong‐Won; Seo, Woo‐Keun; Bang, Oh Young; Ay, Hakan; Kim, Gyeong‐Moon

doi:10.1007/s10072-020-04958-6

Cited by 13 publications

(11 citation statements)

References 24 publications

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“…Yet, systemic pathological processes underlying the development of CAS also affect the cerebral resistance vessels. There is growing evidence that consequences of CAS extend into the cerebral microcirculation, contributing to the development of small vessel disease and promoting micro-infarcts [6,16], white matter damage [17][18][19][20] and lacunar infarcts [21,22] and thereby exacerbating the pathogenesis of VCI. Additionally, pathological processes underlying the development of CAS also result in pathological remodeling of the microcirculatory network [23][24][25][26][27][28].…”

Section: Introductionmentioning

confidence: 99%

Imaging retinal microvascular manifestations of carotid artery disease in older adults: from diagnosis of ocular complications to understanding microvascular contributions to cognitive impairment

et al. 2021

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Carotid artery stenosis (CAS) is a consequence of systemic atherosclerotic disease affecting the aging populations of the Western world. CAS is frequently associated with cognitive impairment. However, the mechanisms contributing to the development of vascular cognitive impairment (VCI) associated with CAS are multifaceted and not fully understood. In addition to embolization and decreased blood flow due to the atherosclerotic lesion in the carotid artery, microcirculatory dysfunction in the cerebral circulation also plays a critical role in CAS-related VCI. To better understand the microvascular contributions to cognitive decline associated with CAS and evaluate microvascular protective effects of therapeutic interventions, it is essential to examine the structural and functional changes of the microvessels in the central nervous system (CNS). However, there are some limitations of in vivo brain vascular imaging modalities. The retinal microvasculature provides a unique opportunity to study pathogenesis of cerebral small vessel disease and VCI, because the cerebral circulation and the retinal circulation share similar anatomy, physiology and embryology. Similar microvascular pathologies may manifest in the brain and the retina, thus ocular examination can be used as a noninvasive screening tool to investigate pathological changes in the CNS associated with CAS. In this review, ocular signs of CAS and the retinal manifestations of CAS-associated microvascular dysfunction are discussed. The advantages and limitation of methods that are capable of imaging the ocular circulation (including funduscopy, fluorescein angiography, Doppler sonography, optical coherence tomography [OCT] and optical coherence tomography angiography [OCTA]) are discussed. The potential use of dynamic retinal vessel analysis (DVA), which allows for direct visualization of neurovascular coupling responses in the CNS, for understanding microvascular contributions to cognitive decline in CAS patients is also considered.

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Section: Introductionmentioning

confidence: 99%

Imaging retinal microvascular manifestations of carotid artery disease in older adults: from diagnosis of ocular complications to understanding microvascular contributions to cognitive impairment

et al. 2021

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“…White matter, gray matter and substantia nigra are three important components of the central nervous system. There exists strong evidence showing that white matter hyperintensities (WMH) is an important clinical markers of several brain diseases, such as stroke, dementia, in both cross-sectional and longitudinal studies (Balakrishnan et al, 2021 ; Song et al, 2021 ). Degeneration of the nigra cells leads to a decrease in dopamine neurons, which causes Parkinson's disease (PD).…”

Section: Introductionmentioning

confidence: 99%

Outer Retinal Layer Thickness Changes in White Matter Hyperintensity and Parkinson's Disease

Zhao

et al. 2021

Front. Neurosci.

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Purpose: To investigate the thickness changes of outer retinal layers in subjects with white matter hyperintensities (WMH) and Parkinson's Disease (PD).Methods: 56 eyes from 31 patients with WMH, 11 eyes from 6 PD patients, and 58 eyes from 32 healthy controls (HC) were enrolled in this study. A macular-centered scan was conducted on each participant using a spectral-domain optical coherence tomography (SD-OCT) device. After speckle noise reduction, a state-of-the-art deep learning method (i.e., a context encoder network) was employed to segment the outer retinal layers from OCT B-scans. Thickness quantification of the outer retinal layers was conducted on the basis of the segmentation results.Results: WMH patients had significantly thinner Henle fiber layers, outer nuclear layers (HFL+ONL) and photoreceptor outer segments (OS) than HC (p = 0.031, and p = 0.005), while PD patients showed a significant increase of mean thickness in the interdigitation zone and the retinal pigment epithelium/Bruch complex (IZ+RPE) (19.619 ± 4.626) compared to HC (17.434 ± 1.664). There were no significant differences in the thickness of the outer plexiform layer (OPL), the myoid and ellipsoid zone (MEZ), and the IZ+RPE layer between WMH and HC subjects. Similarly, there were also no obvious differences in the thickness of the OPL, HFL+ONL, MEZ and the OS layer between PD and HC subjects.Conclusion: Thickness changes in HFL+ONL, OS, and IZ+RPE layers may correlate with brain-related diseases such as WMH and PD. Further longitudinal study is needed to confirm HFL+ONL/OS/IZ+RPE layer thickness as potential biomarkers for detecting certain brain-related diseases.

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“…If the total CSVD burden is associated with presence of IPH, it may be another effective imaging marker for indicating clinical symptoms. Actually, previous longitudinal studies (4,5) demonstrated that WMHs and lacunes can identify a high-risk group for ischemic events in patients with carotid stenosis. Similarly, whether "the total CSVD burden" can distinguish the severity of symptoms in carotid stenosis has not been reported.…”

Section: Introductionmentioning

confidence: 99%

“…CSVD can be observed in about two-thirds of patients with carotid stenosis ( 3 ). In patients with carotid stenosis, CSVD is associated with increased risks of long-term cardiovascular death ( 3 ) and future stroke ( 4 , 5 ) and adversely affects postoperative cognition ( 6 ). Therefore, a better understanding of the pathogenesis for CSVD in carotid stenosis would help improve patients' prognosis.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2021

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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.

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White matter hyperintensity determines ischemic stroke severity in symptomatic carotid artery stenosis

Cited by 13 publications

References 24 publications

Imaging retinal microvascular manifestations of carotid artery disease in older adults: from diagnosis of ocular complications to understanding microvascular contributions to cognitive impairment

Imaging retinal microvascular manifestations of carotid artery disease in older adults: from diagnosis of ocular complications to understanding microvascular contributions to cognitive impairment

Outer Retinal Layer Thickness Changes in White Matter Hyperintensity and Parkinson's Disease

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

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