Stroke patients with cerebral microbleeds on MRI scans have arteriolosclerosis as well as systemic atherosclerosis

Abstract

Cerebral microbleeds (CMBs) are recognized as a manifestation of arteriolosclerosis in cerebral small vessels. However, little is known regarding whether stroke patients with CMBs often have systemic atherosclerosis. The aim of the present study was to elucidate this issue using the cardio-ankle vascular index (CAVI), a new index of systemic atherosclerosis, in acute ischemic stroke patients. We prospectively studied 105 patients (71 males, median age ¼ 70.0 years) with acute ischemic stroke. All of the patients were examined using T2*-weighted gradient echo magnetic resonance imaging (MRI) to look for and assess the CMBs and using fluid-attenuated inversion recovery to evaluate white matter hyperintensity (WMH). We assigned the patients into CMB and non-CMB groups and compared the clinical characteristics of these groups. The factors associated with CMBs were investigated using multivariate logistic regression analysis. T2*-weighted gradient echo MRI revealed CMBs in 47 patients (44.8%) and no CMBs in 58 patients (55.2%). The CAVI was significantly higher in the CMBs group (10.5 vs. 8.6, Po0.001).In the multivariate logistic regression analysis, CAVI per one point increase (odds ratio (OR), 1.50; 95% confidence interval (CI), 1.12-2.00; P ¼ 0.006), advanced WMH (OR, 4.78; 95% CI, 1.55-14.74; P ¼ 0.006) and impaired kidney function (OR, 3.31; 95% CI, 1.16-9.81; P ¼ 0.031) were independent factors associated with the presence of CMBs. A high CAVI was independently associated with CMBs in patients with acute ischemic stroke. Our results indicated that ischemic stroke patients with CMBs may have cerebral arteriolosclerosis as well as systemic atherosclerosis.

Volumetric Analysis of Carotid Plaque Components and Cerebral Microbleeds: A Correlative Study

“…This can be explained with a common underlying process that interacts with atherosclerosis that involves carotid arteries as well as atherosclerosis at the level of the microvessel, which are damages and allow blood to leak outside the vessels. In a recent paper by Shimoyama et al, 31 an association was found between CMBs and systemic atherosclerosis in a population of 105 patients.…”

Cardio-ankle vascular index (CAVI) as an indicator of arterial stiffness

“…The clinical significance of CAVI in this aspect is not the evaluation of the severity of a full-blown disease, but its capability of detecting subtle and subclinical intracranial vascular pathologies instead. In addition to being an independent factor associated with cerebral microbleeds in patients with acute ischemic stroke,45 CAVI has also been shown to be independently correlated with silent brain infarct 46. Moreover, the presence of cerebral small vessel diseases in asymptomatic young and middle-aged subjects has also been found to be significantly associated with their CAVI scores 47.…”

Outcome markers for clinical trials in cerebral amyloid angiopathy

“…97 Trials to establish specific therapies for common age-related small vessel pathologies, like those for CAA, would be greatly facilitated by study outcomes that are clinically and biologically meaningful, statistically efficient, and generalizable across sites. Nearly all of the measures of tissue injury and altered physiology described above are observed as well in arteriolosclerosis or chronic hypertensive vasculopathy, 14, 56, 98-100 suggesting that these markers may represent general features of damage to the small cerebral vessels. No in vivo methods have yet emerged to measure arteriolosclerosis pathology in an analogous fashion to PiB detection of CAA, however, highlighting the importance of achieving further progress in molecular imaging of small vessel diseases.…”