Intracranial Carotid Arteriosclerosis Mediates the Association Between Blood Pressure and Cerebral Small Vessel Disease

Melgarejo, Jesús D.; Vernooij, Meike W.; Ikram, M. Arfan; Zhang, Zhen-Yu; Bos, Daniël

doi:10.1161/hypertensionaha.122.20434

Cited by 6 publications

(2 citation statements)

References 36 publications

(62 reference statements)

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“…On the other hand, increased pulsatile wave transmission from the aorta to the microcirculation caused by arterial stiffness may also be hazardous to cerebral microvasculature 26 . In line with our findings, a recent study identified that the volume of medial IAC, rather than that of intimal IAC, mediates the association between blood pressure and WMH 27 . These findings indicate that medial IAC, as a proxy for arterial stiffness, may play an independent role in the pathogenesis of CSVD.…”

Section: Discussionsupporting

confidence: 92%

The correlation between medial pattern of intracranial arterial calcification and white matter hyperintensities

Zheng

et al. 2023

Preprint

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Background:Despite previously reported correlations between intracranial arterial calcification (IAC) and white matter hyperintensities (WMH), little is known about the relationship between IAC pattern and WMH. By differentiating intimal and medical IAC, we aimed to investigate the relationship between IAC pattern and WMH. <break><break>Methods:Consecutive patients with acute ischemic stroke were included. IAC pattern was categorized as intimal or medial on plain brain CT. The number of cerebral arteries involved by IAC for each patient was recorded. IAC severity of each artery was defined as focal or diffuse. On brain MRI, the burden of WMH was graded on a visual rating scale and classified as absent mild, moderate and severe. Multiple logistic regression was performed to examine the relationship between IAC and WMH. <break><break>Results:Among 265 recruited patients, intimal IAC was detected in 54.7% patients, medial IAC in 48.5% patients and coexistent (intimal and medial) IAC in 52.1% patients. Diffuse IAC was in 27.9% patients, all of which were medial IACs. WMH was found in 75.5% patients, including 105 patients (39.6%) with mild WMH, 69 (26.0%) with moderate WMH and 26 (9.8%) with severe WMH. The presence and severity of medial IAC were correlated with WMH occurrence (p<0.001, respectively). Chi-square linear trend suggested the number of arteries involved by medial IAC (p<0.001) and the severity of medial IAC (p<0.001) were correlated with WMH burden. After adjusting age, hypertension, history of stroke and history of ischemic heart disease, multiple ordinal regression demonstrated a positive correlation between the number of arteries involved by medial IAC (p<0.001) and the severity of medial IAC (p<0.001) with the overall burden of WMH. <break><break>Conclusions:Medial IAC was correlated with the burden of WMH. The dose-effect relationship between IAC and WMH suggests the need of further investigations on shared underlying mechanisms of intracranial large artery disease and cerebral small vessel disease.

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Section: Discussionsupporting

confidence: 92%

The correlation between medial pattern of intracranial arterial calcification and white matter hyperintensities

Zheng

et al. 2023

Preprint

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“…We also found that patients with preoperative hypertension had a significantly increased risk of developing PND. Previous studies have reported that hypertension is one of the most important risk factors for the incidence of CVD 22 , and patients with preoperative hypertension have a significantly increased risk of developing postoperative cognitive impairment 23 . Long-term fluctuations in blood pressure can damage the structure of the walls of the cerebral blood vessels and affect the self-regulatory function of cerebral blood flow.…”

Section: Discussionmentioning

confidence: 99%

Association between cerebrovascular disease and perioperative neurocognitive disorders: a retrospective cohort study

Feng,

Liu,

et al. 2023

International Journal of Surgery

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Background: Previous studies have shown that patients with cerebrovascular disease (CVD) have a significantly increased risk of cognitive decline or dementia; however, the association between preoperative CVD and perioperative neurocognitive disorders (PNDs) remains unclear. This study aimed to explore the correlation between preoperative CVD and PNDs, as well as combine logistic regression and ROC curves to construct a clinical prediction PND model. Materials and Methods: This retrospective cohort study evaluated 13,899 surgical patients of a large-scale comprehensive hospital between January 2021 and January 2022 to explore the association between preoperative CVD and PNDs, with follow-up to monitor postoperative survival until February 28, 2023, unless the patient died. The study participants comprised all inpatients from the Bone and Joint Surgery, Spine Surgery, Urology, Hepatobiliary Surgery, Gastrointestinal Surgery, and Thoracic Surgery departments. Patients were classified into two groups: the CVD group with a confirmed diagnosis and the non-cerebrovascular disease (NCVD) group. The incidence of PNDs was measured, and potential associations between patient demographic information, preoperative comorbidities, and CVD, as well as the correlation between preoperative CVD and PNDs, were investigated by multivariate logistic regression analysis. Next, we constructed a clinical prediction PND model by drawing the receiver operating characteristic (ROC) curve. The postoperative survival of all patients was tracked, and a survival curve was constructed and incorporated into the Cox proportional hazard regression model to analyze the relationship between preoperative CVD and overall postoperative survival rate. Results: Of the included 13,899 patients, propensity score matching yielded 1006 patient pairs. Multivariate logistic regression analysis revealed that CVD was an independent risk factor for PNDs [Odds ratio: 10.193; 95% confidence interval: 7.454–13.938; P<0.001]. Subsequently, we developed a clinical prediction model for PNDs by multivariate logistic regression analysis. The area under the ROC curve was 0.798 (95% CI: 0.765–0.830). The survival of 11,702 patients was followed up. Multivariate Cox hazard ratio regression analysis revealed that CVD affected the overall postoperative survival rate (Hazard ratio, 1.398; 95% confidence interval: 1.112–1.758; P＜0.001). Conclusion: CVD was an independent risk factor for PNDs and affected the overall postoperative survival rate of surgical patients with preoperative CVD.

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Intracranial arterial calcification in patients with unruptured and ruptured intracranial aneurysms

Kamphuis,

van der Kamp,

Lette

et al. 2024

Eur Radiol

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Objectives Arterial calcification is thought to protect against rupture of intracranial aneurysms, but studies in a representative population of intracranial aneurysm patients have not yet been performed. The aim was to compare the prevalence of aneurysm wall calcification and intracranial carotid artery calcification (ICAC) between patients with an unruptured intracranial aneurysm (UIA) and a ruptured intracranial aneurysm (RIA). Materials and methods We matched 150 consecutive UIA patients to 150 RIA patients on age and sex. Aneurysm wall calcification and ICAC were quantified on non-contrast enhanced computed tomography images with the modified Agatston score. We compared the prevalence of aneurysm wall calcification, ICAC, and severe ICAC (defined as a modified Agatston score in the fourth quartile) between UIA and RIA patients using univariate and multivariate conditional logistic regression models adjusted for aneurysm characteristics and cardiovascular risk factors. Results Aneurysm wall calcification was more prevalent in UIA compared to RIA patients (OR 5.2, 95% CI: 2.0–13.8), which persisted after adjustment (OR 5.9, 95% CI: 1.7–20.2). ICAC prevalence did not differ between the two groups (crude OR 0.9, 95% CI: 0.5–1.8). Severe ICAC was more prevalent in UIA patients (OR 2.0, 95% CI: 1.1–3.6), but not after adjustment (OR 1.0, 95% CI: 0.5–2.3). Conclusions Aneurysm wall calcification but not ICAC was more prevalent in UIAs than in RIAs, which corresponds to the hypothesis that calcification may protect against aneurysmal rupture. Aneurysm wall calcification should be further assessed as a predictor of aneurysm stability in prospective cohort studies. Clinical relevance statement Calcification of the intracranial aneurysm wall was more prevalent in unruptured than ruptured intracranial aneurysms after adjustment for cardiovascular risk factors. Calcification may therefore protect the aneurysm against rupture, and aneurysm wall calcification is a candidate predictor of aneurysm stability. Key Points Aneurysm wall calcification was more prevalent in patients with unruptured than ruptured aneurysms, while internal carotid artery calcification was similar. Aneurysm wall calcification but not internal carotid artery calcification is a candidate predictor of aneurysm stability. Cohort studies are needed to assess the predictive value of aneurysm wall calcification for aneurysm stability. Graphical Abstract

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Intracranial Carotid Arteriosclerosis Mediates the Association Between Blood Pressure and Cerebral Small Vessel Disease

Cited by 6 publications

References 36 publications

The correlation between medial pattern of intracranial arterial calcification and white matter hyperintensities

The correlation between medial pattern of intracranial arterial calcification and white matter hyperintensities

Association between cerebrovascular disease and perioperative neurocognitive disorders: a retrospective cohort study

Intracranial arterial calcification in patients with unruptured and ruptured intracranial aneurysms

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