Relationship between carotid arterial properties and cerebral white matter hyperintensities

Abstract

Objective: Since arterial stiffness is a functional measure of arterial compliance and may be an important marker of cerebrovascular disease, we examined the association of carotid artery stiffness with white matter hyperintensity volume (WMHV) in a cross-sectional study of 1,166 strokefree participants.Methods: Carotid beta stiffness index (STIFF) was assessed by M-mode ultrasound of the common carotid artery and calculated as the ratio of natural log of the difference between systolic and diastolic blood pressure over STRAIN, a ratio of the difference between carotid systolic and diastolic diameter (DD) divided by DD. WMHV was measured by fluid-attenuated inversion recovery MRI. The associations of STIFF, DD, and STRAIN with WMHV were examined using linear regression after adjusting for sociodemographic, lifestyle, and vascular risk factors. Results:In a fully adjusted model, larger carotid DD was significantly associated with greater log-WMHV (b 5 0.09, p 5 0.001). STIFF and STRAIN were not significantly associated with WMHV. In adjusted analyses stratified by race-ethnicity, STRAIN (b 5 21.78, p 5 0.002) and DD (b 5 0.11, p 5 0.001) were both associated with greater log-WMHV among Hispanic participants, but not among black or white participants.Conclusions: Large carotid artery diameters are associated with greater burden of white matter hyperintensity (WMH) in this multiethnic population. The association between increased diameters, decreased STRAIN, and greater WMH burden is more pronounced among Hispanics. These associations suggest a potential important pathophysiologic role of extracranial large artery remodeling in the burden of WMH. Neurology ® 2017;88:2036-2042 GLOSSARY BMI 5 body mass index; CCA 5 common carotid artery; CI 5 confidence interval; cIMT 5 carotid intima media thickness; DBP 5 diastolic blood pressure; DD 5 diastolic diameter; FLAIR 5 fluid-attenuated inversion recovery; HDL 5 high-density lipoprotein; ICA 5 internal carotid artery; ICV 5 intracranial volume; IMT 5 intima media thickness; LDL 5 low-density lipoprotein; NOMAS 5 Northern Manhattan Study; OR 5 odds ratio; PWV 5 pulse wave velocity; SBI 5 silent brain infarction; SBP 5 systolic blood pressure; WMH 5 white matter hyperintensity; WMHV 5 white matter hyperintensity volume.

Differential impact of white matter hyperintensities on long-term outcomes in ischemic stroke patients with large artery atherosclerosis

“…A previous study reported that a higher burden of WMH was found in patients with a higher degree of carotid stenosis [ 8 ]. On the other hands, arterial stiffness may explain the association between LAA and severe WMH [ 9 ]. Previous study showed that increased arterial stiffness is strongly associated with large artery atherosclerosis at various arterial trees [ 14 ].…”

“…The small vessel disease is associated with microvascular pathogenesis including endothelial dysfunction and leakage of the blood-brain barrier. Recent studies also showed that WMH is also associated with large artery atherosclerosis (LAA) [ 6 – 9 ].…”

Journal Club: Relationship between carotid arterial properties and cerebral white matter hyperintensities

“…2. That Rundek et al 4 found this association in individuals largely without cerebrovascular disease suggests this marker may be used to detect disease while still in a preclinical state. 3.…”

“…Rundek et al 4 demonstrated that carotid artery diastolic diameter is associated with WMH in a large sample of ethnically diverse, elderly, but otherwise healthy individuals. The particular novelty is the association being preserved after covariation with known cerebrovascular disease risk factors.…”

“…This Journal Club article reports on a study from Rundek et al, 4 who identified a novel noninvasive marker of white matter hyperintensities (WMH) within the cerebral cortex. The study presents an association between carotid diastolic diameter and WMH, potentially highlighting a method to noninvasively detect WMH burden.…”