Carotid disease, cognition, and aging: time to redefine asymptomatic disease?

Lineback, Christina; Stamm, Brian; Sorond, Farzaneh A.; Caprio, Fan Z.

doi:10.1007/s11357-022-00688-z

Cited by 9 publications

(2 citation statements)

References 52 publications

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“…Marked stenosis or occlusion of the common or internal carotid arteries may cause ocular hypoperfusion (Lee et al, 2022 ) and/or cerebral hypoperfusion (Lineback et al, 2022 ). Ocular ischemic syndrome (OIS), attributable to chronic ocular hypoperfusion, is one of the important factors that cause ocular neurodegenerative diseases (Mester et al, 2009 ), such as optic atrophy (Battista et al, 2022 ).…”

Section: Introductionmentioning

confidence: 99%

Blood flow perfusion in visual pathway detected by arterial spin labeling magnetic resonance imaging for differential diagnosis of ocular ischemic syndrome

Chen

Xue²,

Huang³

et al. 2023

Front. Neurosci.

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BackgroundOcular ischemic syndrome (OIS), attributable to chronic hypoperfusion caused by marked carotid stenosis, is one of the important factors that cause ocular neurodegenerative diseases such as optic atrophy. The current study aimed to detect blood flow perfusion in a visual pathway by arterial spin labeling (ASL) and magnetic resonance imaging (MRI) for the differential diagnosis of OIS.MethodsThis diagnostic, cross-sectional study at a single institution was performed to detect blood flow perfusion in a visual pathway based on 3D pseudocontinuous ASL (3D-pCASL) using 3.0T MRI. A total of 91 participants (91 eyes) consisting of 30 eyes with OIS and 61 eyes with noncarotid artery stenosis-related retinal vascular diseases (39 eyes with diabetic retinopathy and 22 eyes with high myopic retinopathy) were consecutively included. Blood flow perfusion values in visual pathways derived from regions of interest in ASL images, including the retinal-choroidal complex, the intraorbital segments of the optic nerve, the tractus optics, and the visual center, were obtained and compared with arm-retinal circulation time and retinal circulation time derived from fundus fluorescein angiography (FFA). Receiver operating characteristic (ROC) curve analyses and the intraclass correlation coefficient (ICC) were performed to evaluate the accuracy and consistency.ResultsPatients with OIS had the lowest blood flow perfusion values in the visual pathway (all p < 0.05). The relative intraorbital segments of optic nerve blood flow values at post-labeling delays (PLDs) of 1.5 s (area under the curve, AUC = 0.832) and the relative retinal–choroidal complex blood flow values at PLDs of 2.5 s (AUC = 0.805) were effective for the differential diagnosis of OIS. The ICC of the blood flow values derived from the retinal–choroidal complex and the intraorbital segments of the optic nerve between the two observers showed satisfactory concordance (all ICC > 0.932, p < 0.001). The adverse reaction rates of ASL and FFA were 2.20 and 3.30%, respectively.Conclusion3D-pCASL showed that the participants with OIS had lower blood flow perfusion values in the visual pathway, which presented satisfactory accuracy, reproducibility, and safety. It is a noninvasive and comprehensive differential diagnostic tool to assess blood flow perfusion in a visual pathway for the differential diagnosis of OIS.

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Section: Introductionmentioning

confidence: 99%

Blood flow perfusion in visual pathway detected by arterial spin labeling magnetic resonance imaging for differential diagnosis of ocular ischemic syndrome

Chen

Xue²,

Huang³

et al. 2023

Front. Neurosci.

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“…Increasing attention, however, has focused on the risk of cognitive impairment in such patients as life expectancy increases worldwide 3,4 . In particular, recent studies 3,5 have suggested that despite being clinically “asymptomatic,” patients with asymptomatic carotid stenosis (ACS) may experience cognitive impairment, hemodynamic consequences, and silent lesions.…”

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confidence: 99%

Altered Callosal Morphology and Connectivity in Asymptomatic Carotid Stenosis

Liu

Zhong

et al. 2023

Magnetic Resonance Imaging

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BackgroundCarotid stenosis, even in the clinically asymptomatic stage, causes cognitive impairment, silent lesions, and hemispheric changes. The corpus callosum (CC) is crucial for hemispheric cortical integration and specialization.PurposeTo examine if CC morphology and connectivity relate to cognitive decline and lesion burden in asymptomatic carotid stenosis (ACS).Study TypeRetrospective, cross‐sectional.Population33 patients with unilaterally severe (70%) ACS and 28 demographically and comorbidity‐matched controls. A publicly available healthy adult lifespan (ages between 18 and 80; n = 483) MRI dataset was also included.Field Strength/SequenceA 3.0 T; T1 MPRAGE and diffusion weighted gradient echo‐planar imaging sequences.AssessmentStructural MRI and multidomain cognitive data were obtained. Midsagittal CC area, circularity, thickness, integrity, and probabilistic tractography were calculated and correlated with cognitive tests and white matter hyperintensity. Fractional anisotropy, mean diffusivity (MD), and radial diffusivity were determined from DTI.Statistical TestsIndependent two‐sample t‐tests, χ2 tests, Mann–Whitney U, locally weighted scatterplot smoothing (LOWESS) curve fit, and Pearson correlation. A P value < 0.05 was considered statistically significant.ResultsPatients with ACS demonstrated significant reductions in callosal area, circularity, and thickness compared to controls. The callosal atrophy was significantly correlated with white matter hyperintensity size (r = −0.629, P < 0.001). Voxel‐wise analysis of diffusion measures in the volumetric CC showed that ACS patients exhibited significantly lower fractional anisotropy and higher MD and radial diffusivity in the genu and splenium of the CC than controls. Further lifespan trajectory analysis showed that although the midsagittal callosal area, circularity, and thickness exhibited age‐related decreases, the values in the ACS patients were significantly lower in all age groups.Data ConclusionMidsagittal callosal atrophy and connectivity reflect the load of silent lesions and the severity of cognitive decline, respectively, suggesting that CC degeneration has potential to serve as an early marker in ACS.Level of Evidence3Technical Efficacy Stage2

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