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

Abstract

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.

Current and Future Treatments of Vascular Cognitive Impairment

“…51,52 Recent studies also showed that asymmetry of cerebral perfusion due to LAD may give rise to a preferential increase in WMH and dilated periventricular space. [53][54][55] As discussed earlier, studies also showed an association between LAD and AD pathologies. LAD may also possibly have an etiological association with AD as the hypoperfusion related to the LAD or its obliteration of perforators can compromise the neurovascular units and BBB integrity, thus triggering amyloid/tau accumulation and the AD pathological cascades as well.…”

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

“…Our study was conducted to verify the correlation between ICAS and WMHs; however, the results were borderline. Several studies on ICAS and WMHs were excluded because of the lack of data available for meta-analysis, which reported contradictory results, including positive and null associations ( Chutinet et al, 2012 ; Li et al, 2014 ; Nam et al, 2017 ; Zhai et al, 2018 ; Zhao et al, 2019 ; Ren et al, 2021 ; Feng et al, 2023 ). The inconsistencies in the results might be due to the differences in study subjects, sample size, ICAS assessment method, WMHs rating method and statistical analysis between the studies.…”

“…Endothelial dysfunction (including cerebral blood flow, cerebrovascular reactivity, intracranial pulsatility) is a pivotal pathogenesis of cerebral small vessel disease ( Wardlaw et al, 2019 ). Three studies reported that WMHs were not directly related to arterial stenosis but were independently associated with the stenosis-induced cerebral hemodynamic changes in patients with ICAS ( Fang et al, 2020 ; Ren et al, 2021 ; Feng et al, 2023 ). Intracranial and extracranial atherosclerotic stenosis does not necessarily cause decreased cerebral blood flow ( Shakur et al, 2014 ) as it also depends on collateral blood flow, which may result in a null association between intracranial and extracranial atherosclerotic stenosis and WMHs in some previous studies.…”

Hemodynamic significance of intracranial atherosclerotic disease and ipsilateral imaging markers of cerebral small vessel disease

“…For instance, cerebral hypoperfusion has been associated with more severe WMHs in the general population and in patients with symptomatic ICAD (sICAD). 8,9 Moreover, thromboembolism and cerebral hypoperfusion have been associated with presence of CMIs. 10 These all need further investigations.…”