Severity of Intracranial Large Artery Disease Correlates With Cerebral Small Vessel Disease

Wang, Xueyang; Lyu, Jinhao; Zhang, Sen-hao; Duan, Caohui; Duan, Qi; Ma, Xiaoxiao; Zhang, Ting-yang; Zhang, Jing; Tian, Chenglin; Lou, Xin

doi:10.1002/jmri.28004

Cited by 7 publications

(6 citation statements)

References 38 publications

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“…Following a review of the full texts and a manual search, 21 studies were included in the meta-analyses. Of these, 14 studies were pooled to calculate the OR ( Pu et al, 2009 ; Romero et al, 2009 ; Muñoz-Cortés et al, 2013 ; Schulz et al, 2013 ; Park et al, 2015 ; Duan et al, 2018 ; Ye et al, 2019 ; Del Brutto et al, 2020 ; Fang et al, 2020 ; Benli et al, 2021 ; Yin et al, 2021 ; Choi et al, 2022 ; Huang et al, 2022 ; Wang et al, 2022 ), and seven studies were pooled to calculate the SMD ( Patankar et al, 2006 ; Chuang et al, 2011 ; Lee et al, 2011 ; Cheng et al, 2012 ; Scherr et al, 2012 ; Sahin et al, 2015 ; Ghaznawi et al, 2022 ).…”

Section: Resultsmentioning

confidence: 99%

“…Therefore, it is necessary to determine whether ICAS, similar to ECAS, is related to WMHs. To date, a considerable number of recent studies have been published investigating the correlation between intracranial and extracranial atherosclerotic stenosis and white matter hyperintensities (WMHs) ( Duan et al, 2018 ; Ye et al, 2019 ; Del Brutto et al, 2020 ; Fang et al, 2020 ; Benli et al, 2021 ; Yin et al, 2021 ; Choi et al, 2022 ; Ghaznawi et al, 2022 ; Huang et al, 2022 ; Wang et al, 2022 ). In light of this, we conducted an updated systematic review and meta-analysis to examine the potential association between ICAS or ECAS and WMHs.…”

Section: Introductionmentioning

confidence: 99%

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Association between intracranial and extracranial atherosclerosis and white matter hyperintensities: a systematic review and meta-analysis

Zhang,

Fu,

Zhan

2024

Front. Aging Neurosci.

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BackgroundWhite matter hyperintensities (WMHs) are key neuroimaging markers of cerebral small vessel diseases. This study aimed to investigate whether intracranial and extracranial atherosclerotic stenosis is associated with WMHs.MethodsFollowing a previously registered protocol (PROSPERO protocol: CRD42023407465), PubMed, Web of Science, and Embase were systematically searched for relevant literature published until March 2023. Cross-sectional studies examining the association between intracranial and extracranial atherosclerotic stenosis and WMHs were included. Random effects models were used to calculate the pooled estimates.ResultsTwenty-one eligible studies, including 10,841 participants, were identified. Intracranial and extracranial atherosclerotic stenosis was associated with an increased risk of WMHs (OR 1.80, 95% CI 1.25–2.57, I2 = 75%) and increased WMH volumes (SMD 0.40, 95% CI 0.18–0.63, I2 = 63%). Heterogeneity resulted from the WMHs rating method and the location. Extracranial atherosclerotic stenosis (ECAS) was significantly associated with WMHs (OR 2.10, 95% CI 1.22–3.62, I2 = 71%), but intracranial atherosclerotic stenosis (ICAS) was insignificantly associated with WMHs (OR 1.75, 95% CI 0.97–3.15, I2 = 84%). The association was stable in the subgroup analysis based on WMHs location, which included deep WMHs and periventricular WMHs.ConclusionIntracranial and extracranial atherosclerotic stenosis is associated with WMHs. This association is significant in ECAS, but attenuated in ICAS.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Association between intracranial and extracranial atherosclerosis and white matter hyperintensities: a systematic review and meta-analysis

Zhang,

Fu,

Zhan

2024

Front. Aging Neurosci.

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“…Wang et al. ( 2022 ) performed a retrospective study on 516 patients with intracranial atherosclerosis (ICAS) and found that there was no correlation between WMHs and the severity of large arterial stenosis. Their findings are consistent with the results of this study.…”

Section: Discussionmentioning

confidence: 99%

“…However, nowadays, more academics believe that there is a relationship between WMHs and large vessels in the brain. Wang et al (2022) CBV is defined as the volume occupied by intravascular blood within a particular quantity of brain tissue (including capillaries and large vessels). A drop in CBV denotes poor cerebral microcirculation.…”

Section: Discussionmentioning

confidence: 99%

White matter hyperintensities had a correlation with the cerebral perfusion level, but no correlation with the severity of large vessel stenosis in the anterior circulation

et al. 2023

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Objective The contribution of large vessel stenosis to the development of white matter hyperintensities (WMHs) has not been fully elucidated. This study aims to explore the correlation between ipsilateral white matter hyperintensities (WMHs) and the severity of large vessel stenosis in the anterior circulation and cerebral perfusion level, as well as analyze the factors influencing WMHs. Methods A cross‐sectional study of 150 patients with unilateral anterior circulation large vessel stenosis of ≥50% was conducted. The severity of ipsilateral WMHs was assessed by Fazekas scale on T2‐weighted image and/or fluid‐attenuated inversion recovery MR imaging, vascular stenosis severity was evaluated on computed tomography angiography images, and the level of cerebral perfusion was rated according to a staging system for abnormal cerebral perfusion based on CTP results. The relationships between the stenosis severity, cerebral perfusion level and ipsilateral WMHs severity were analyzed. A multivariate logistic regression analysis was performed to determine the factors independently influencing WMHs. Results Among 150 patients (mean age, 63.12 ± 10.55 years), there was a statistically significant positive correlation between cerebral perfusion level and the severity of DWMHs and PWMHs (Gamma = 0.561, p < .001; Gamma = 0.600, p < .001), and a positive correlation between cerebral perfusion level and the severity of vascular stenosis (Gamma = 0.495, p < .001).While, there was no statistically significant correlation between the severity of vascular stenosis and the severity of DWMHs and PWMHs (Gamma = 0.188, p = .08; Gamma = 0.196, p = .06). The multivariate logistic regression analysis results demonstrated that age (OR = 1.047, 95% CI 1.003–1.093; p = .035), stroke/TIA history (OR = 2.880, 95% CI 1.154–7.190; p = .023) and stage II of cerebral perfusion (OR = 2.880, 95% CI 1.154–7.190; p = .023) were independent influencing factors on ipsilateral DWMHs. Age (OR = 1.051, 95% CI 1.009–1.094; p = .018), and stage II of cerebral perfusion (OR = 12.871, 95% CI 3.576‐46.322; p < .001) were factors independently influencing ipsilateral PWMHs. Conclusion White matter hyperintensities may be attributed to cerebral hypoperfusion secondary to vascular stenosis but not directly to the severity of stenosis in the large vessels of anterior circulation. Moreover, longitudinal studies with sequential imaging exams may further reveal the impact of cerebral perfusion secondary to vascular stenosis on the development and progression of WMHs.

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“…In severe ICAS patients, up to 60% have evidence of CSVD on brain MRI. 12,29 The severity of ICAS in the anterior circulation is associated with the CSVD burden. 29 Severe symptomatic ICAS patients with CSVD may have a higher risk of recurrent stroke than those without CSVD; however, this tendency was observed in the medical arm of the SAMMPRIS trial, but without a significant difference.…”

Section: Discussionmentioning

confidence: 99%

Impact of cerebral small vessel disease on symptomatic in-stent restenosis in intracranial atherosclerosis

Yan

Hou

et al. 2023

Journal of Neurosurgery

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OBJECTIVE Cerebral small vessel disease (CSVD) commonly coexists with intracranial atherosclerotic stenosis (ICAS). In-stent restenosis (ISR) affects the nonprocedural outcome of severe symptomatic ICAS after intracranial stenting. However, only 8%–27% of ISR patients are symptomatic, which highlights the importance of the investigation of risk factors associated with symptomatic ISR (SISR) to improve long-term functional outcome. Whether CSVD is associated with SISR remains unclear. The authors tested the hypothesis that CSVD is associated with SISR in ICAS patients after intracranial stenting. METHODS This retrospective study enrolled 97 patients who were symptomatic due to severe anterior circulation ICAS treated with intracranial stenting. SISR was evaluated with clinical and vascular imaging follow-up. CSVD subtypes, including white matter hyperintensities (WMHs), enlarged perivascular spaces, and chronic lacunar infarctions, were evaluated. Cox regression analysis was used to compare the incidence of SISR between patients with and without CSVD. RESULTS Of the enrolled patients, 58.8% had CSVD. The 1- and 2-year ISR rates were 24.7% and 37.1%, respectively. Of the CSVD subtypes, SISR was associated with deep WMHs (DWMHs; HR 5.39, 95% CI 1.02–28.44). DWMH Fazekas scale grades 2 (HR 85.54, 95% CI 2.42–3018.93) and 3 (HR 66.24, 95% CI 1.87–2352.32) were associated with SISR, but DWMH Fazekas grades 0 and 1 were not. The proportions of SISR in patients with DWMH Fazekas grades 0, 1, 2, and 3 were 16.7%, 33.3%, 50%, and 100%, respectively. CONCLUSIONS Patients with CSVD have a higher risk of SISR than those without CSVD. Of the CSVD subtypes, patients with DWMHs are associated with SISR. The DWMH Fazekas scale score is considered to be a predictor for SISR.

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Severity of Intracranial Large Artery Disease Correlates With Cerebral Small Vessel Disease

Cited by 7 publications

References 38 publications

Association between intracranial and extracranial atherosclerosis and white matter hyperintensities: a systematic review and meta-analysis

Association between intracranial and extracranial atherosclerosis and white matter hyperintensities: a systematic review and meta-analysis

White matter hyperintensities had a correlation with the cerebral perfusion level, but no correlation with the severity of large vessel stenosis in the anterior circulation

Impact of cerebral small vessel disease on symptomatic in-stent restenosis in intracranial atherosclerosis

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