Cerebral small vessel disease and systemic arteriopathy in intracranial arterial dolichoectasia patients

Fierini, Fabio; Poggesi, Anna; Salvadori, Emilia; Acquafresca, Manlio; Fainardi, Enrico; Moretti, Marco; Pantoni, Leonardo

doi:10.1111/ane.13038

Cited by 5 publications

(13 citation statements)

References 31 publications

(55 reference statements)

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“…We also found that CSVD was more common in vertigo patients with VBD than those without VBD. Very recent studies have revealed that CSVD is frequent in stroke patients with intracranial arteries dolichoectasia (Thijs et al, 2017; Zhai et al, 2018; Fierini et al, 2019). Importantly, we evaluated VBD with quantitative image parameters, and found that BAL, and the BL and the TI of the BA were markedly greater (and the TI of the VAs to a lesser extent) in vertigo patients with higher WMH grades (grade 2 and 3) compared to those with lower WMH grades (grade 0 and 1).…”

Section: Discussionmentioning

confidence: 99%

Basilar Artery Tortuosity Is Associated With White Matter Hyperintensities by TIMP-1

et al. 2019

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Background and Purpose To test the hypothesis that the imbalance between matrix metalloproteinases (MMPs) and tissue inhibitor of metalloproteinases (TIMPs) may play a potential role in bridging vertebrobasilar dolichoectasia (VBD) with lacunar infarction (LI) and white matter hyperintensities (WMH). Methods We studied 212 patients with vertigo who underwent multimodal magnetic resonance imaging (MRI) tests for VBD, LI, and WMH identification. We investigated biomarkers of VBD with magnetic resonance angiography (MRA) via various physical characteristics of the vertebrobasilar arteries (VBAs). Similarly, LI and WMH biomarkers were extracted using T2-weighted and fluid attenuated inversion recovery (FLAIR) images. We first determined which of these neuroimaging markers were significant identifiers of VBD, LI and the different grades of WMH. We then sought to draw potential mechanistic conclusions from these MRI-derived parameters, by associating the aforementioned biomarkers with MMP and TIMP serum levels in patient blood samples using non-parametric statistical tests. Results MMP-9 serum level was significantly higher in vertigo patients with VBAs dilation and basilar artery (BA) elongation compared to those with healthy arterial size, and the ratio of MMP-9/TIMP-1 level were higher in those patients. TIMP-1 level was also markedly higher in vertigo patients with BA tortuosity than those without BA tortuosity. The bending length (BL) of the BA was positively correlated with TIMP-1. The length, BL, and tortuosity index of the BA, as well as serum levels of TIMP-1 were greater in patients with higher WMH grades compared to those with low WMH grades. The vertebral artery and BA diameters, and the levels of MMP-2, -3, -9, TIMP-2 and cathepsin L were similar in patients with different WMH grades. Conclusion In vertigo patients, we found various probably associations between MMP-9 and TIMP-1 with arterial alterations linked to both VBD and WMH that may help with the diagnosis and treatment of such diseases in the future.

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Section: Discussionmentioning

confidence: 99%

Basilar Artery Tortuosity Is Associated With White Matter Hyperintensities by TIMP-1

et al. 2019

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“…In 2019, Fierini et al 14 investigated the clinical and demographic characteristics of patients with IADE and described the coexistence of CSVD and systemic arteriopathy. The authors found a variable grade of global cortical atrophy and systemic arterial ectasia in most IADE patients.…”

Section: History Of Clinical and Pathological Research On Iade And Csvdmentioning

confidence: 99%

“…[1][2][3]12 IADE and CSVD are usually investigated separately, 4,6,13 although increasing evidence has indicated that they are associated and should be studied together. 9,14 However, the mechanisms underlying the correlation between IADE and CSVD remain unknown. In this review, we summarize the current concepts and views regarding the association between IADE and CSVD as well as the underlying mechanisms.…”

Section: Introductionmentioning

confidence: 99%

“…Recently, some researchers have proposed a common physiopathology for IADE and CSVD, such as dysfunction of the extracellular matrix (ECM), disrupted proliferation and apoptosis of vascular smooth muscle cells, and mutual hemodynamic alteration [ 1 - 3 , 12 ]. IADE and CSVD are usually investigated separately [ 4 , 6 , 13 ], although increasing evidence has indicated that they are associated and should be studied together [ 9 , 14 ]. However, the mechanisms underlying the correlation between IADE and CSVD remain unknown.…”

Section: Introductionmentioning

confidence: 99%

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Association between Intracranial Arterial Dolichoectasia and Cerebral Small Vessel Disease and Its Underlying Mechanisms

et al. 2020

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Intracranial arterial dolichoectasia (IADE), also known as dilatative arteriopathy of the brain vessels, refers to an increase in the length and diameter of at least one intracranial artery, and accounts for approximately 12% of all patients with stroke. However, the association of IADE with stroke is usually unclear. Cerebral small vessel disease (CSVD) is characterized by pathological changes in the small vessels. Clinically, patients with CSVD can be asymptomatic or present with stroke or cognitive decline. In the past 20 years, a series of studies have strongly promoted an understanding of the association between IADE and CSVD from clinical and pathological perspectives. It has been proposed that IADE and CSVD may be attributed to abnormal vascular remodeling driven by an abnormal matrix metalloproteinase/tissue inhibitor of metalloproteinase pathway. Also, IADErelated hemodynamic changes may result in initiation or progression of CSVD. Additionally, genetic factors are implicated in the pathogenesis of IADE and CSVD. Patients with Fabry’s disease and late-onset Pompe’s disease are prone to developing concomitant IADE and CSVD, and patients with collagen IV alpha 1 or 2 gene (<i>COL4A1/COL4A2</i>) and forkhead box C1 (<i>FOXC1</i>) variants present with IADE and CSVD. Race, strain, familial status, and vascular risk factors may be involved in the pathogenesis of IADE and CSVD. As well, experiments in mice have pointed to genetic strain as a predisposing factor for IADE and CSVD. However, there have been few direct genetic studies aimed towards determining the association between IADE and CSVD. In the future, more clinical and basic research studies are needed to elucidate the causal relationship between IADE and CSVD and the related molecular and genetic mechanisms.

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“…Studies have found that vascular risk factors cause impairment in brain sites related to cognitive and emotional regulation through increased cerebrovascular diseases such as lacunar infarcts or white matter lesions, leading to emotional disorders. 49 It has also been shown that depressed patients cause more severe white matter lesions in brain sites related to cognitive and emotional regulation than non-depressed patients. 50 Moreover, vascular risk factors can also increase the likelihood of stroke, worsen disease symptoms and neurological impairment, and indirectly contribute to PSD as patients with cerebrovascular diseases have more mental stress and negative feelings in the face of sudden illness.…”

Section: Discussionmentioning

confidence: 99%

Predictors of post‐stroke depression: the perspective from the social convoy model

et al. 2023

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BackgroundPost‐stroke depression (PSD) as one of the most common neuropsychiatric disorders after a stroke and is caused by many factors. However, the relationships among different factors and their potential contributions to PSD remain unclear.MethodsTwo hundred and seventy‐six patients were recruited into this study. The general information questionnaire, the Patient Health Questionnaire‐9, the Perceived Social Support Scale, the Family Assessment Device, the General Well‐Being Scale, the Barthel Index, and the modified Rankin Scale were used to assess the condition of patients. Subsequently, we identify the main causes associated with the PSD and then performed a path analysis to clarify the direct, indirect and total effects among the variables.ResultsWe found that age, stroke with coronary heart disease, neurological function, family function, social support, and general well‐being had a significant impact on PSD (P < 0.05). Of these, neurological function had the largest total effect on PSD (β = 0.451), social support contributed the most as a direct effect (β = −0.306), and family function showed the largest indirect effect (β = −0.264).ConclusionIndividual, disease, and social‐psychological factors all contributed to the development of PSD. We should pay more attention to comprehensive assessment, especially for those with poor neurological function, and lacking family or social support. In addition, it would be preferable to provide them with necessary support and care strategies to reduce the incidence of PSD.

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Cerebral small vessel disease and systemic arteriopathy in intracranial arterial dolichoectasia patients

Cited by 5 publications

References 31 publications

Basilar Artery Tortuosity Is Associated With White Matter Hyperintensities by TIMP-1

Basilar Artery Tortuosity Is Associated With White Matter Hyperintensities by TIMP-1

Association between Intracranial Arterial Dolichoectasia and Cerebral Small Vessel Disease and Its Underlying Mechanisms

Predictors of post‐stroke depression: the perspective from the social convoy model

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