The risk factors of old silent brain infarctions in carotid artery stenosis.
Carotid artery stenosis
Risk factors
Silent brain infarctions
Journal
Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology
ISSN: 1590-3478
Titre abrégé: Neurol Sci
Pays: Italy
ID NLM: 100959175
Informations de publication
Date de publication:
Apr 2022
Apr 2022
Historique:
received:
07
03
2021
accepted:
25
09
2021
pubmed:
30
9
2021
medline:
16
3
2022
entrez:
29
9
2021
Statut:
ppublish
Résumé
This study aims to investigate the risk factors of old ipsilateral silent brain infarctions (iSBIs) in patients with internal carotid artery (ICA) stenosis. Consecutive patients with unilateral ICA stenosis ≥ 50% or occlusion were retrospectively enrolled. Old iSBIs were assessed on magnetic resonance imaging. Baseline characteristics and imaging features were compared between patients with and without iSBIs. Multivariable regression analysis was conducted to identify independent risk factors of iSBIs. We enrolled 274 patients with unilateral ICA stenosis ≥ 50% or occlusion. One hundred thirty-three patients had iSBIs to stenosed ICA (48.54%). One hundred thirty-seven patients had recent brain infarction on either side (50.0%). The patients with iSBIs had a lower level of high-density lipoprotein [OR 0.60, 95% CI (0.36-0.96), P = 0.045], higher prevalence of irregular/ulcer plaque [OR 10.71, 95% CI (4.60-24.95), P < 0.0001], and incompleteness of circle of Willis [OR 0.27, 95% CI (0.16-0.45), P < 0.0001] in all enrolled patients. In the patients without recent infarction on either side, lower level of high-density lipoprotein [OR 0.42, 95% CI (0.27-0.88), P = 0.031], higher prevalence of irregular/ulcer plaque [OR 12.73, 95% CI (4.13-39.22), P < 0.0001] and incompleteness of circle of Willis [OR 0.24, 95% CI (0.11-0.50), P = 0.004] were independently associated with iSBIs. The results were similar in ICA stenosis patients with recent brain infarction on either side. In patients with carotid stenosis, incompleteness of circle of Willis, irregular/ulcer plaque, and lower level of high-density lipoprotein were independently associated with old iSBIs.
Sections du résumé
BACKGROUND AND PURPOSE
OBJECTIVE
This study aims to investigate the risk factors of old ipsilateral silent brain infarctions (iSBIs) in patients with internal carotid artery (ICA) stenosis.
METHODS
METHODS
Consecutive patients with unilateral ICA stenosis ≥ 50% or occlusion were retrospectively enrolled. Old iSBIs were assessed on magnetic resonance imaging. Baseline characteristics and imaging features were compared between patients with and without iSBIs. Multivariable regression analysis was conducted to identify independent risk factors of iSBIs.
RESULTS
RESULTS
We enrolled 274 patients with unilateral ICA stenosis ≥ 50% or occlusion. One hundred thirty-three patients had iSBIs to stenosed ICA (48.54%). One hundred thirty-seven patients had recent brain infarction on either side (50.0%). The patients with iSBIs had a lower level of high-density lipoprotein [OR 0.60, 95% CI (0.36-0.96), P = 0.045], higher prevalence of irregular/ulcer plaque [OR 10.71, 95% CI (4.60-24.95), P < 0.0001], and incompleteness of circle of Willis [OR 0.27, 95% CI (0.16-0.45), P < 0.0001] in all enrolled patients. In the patients without recent infarction on either side, lower level of high-density lipoprotein [OR 0.42, 95% CI (0.27-0.88), P = 0.031], higher prevalence of irregular/ulcer plaque [OR 12.73, 95% CI (4.13-39.22), P < 0.0001] and incompleteness of circle of Willis [OR 0.24, 95% CI (0.11-0.50), P = 0.004] were independently associated with iSBIs. The results were similar in ICA stenosis patients with recent brain infarction on either side.
CONCLUSION
CONCLUSIONS
In patients with carotid stenosis, incompleteness of circle of Willis, irregular/ulcer plaque, and lower level of high-density lipoprotein were independently associated with old iSBIs.
Identifiants
pubmed: 34586540
doi: 10.1007/s10072-021-05638-9
pii: 10.1007/s10072-021-05638-9
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
2397-2404Informations de copyright
© 2021. Fondazione Società Italiana di Neurologia.
Références
Smith EE, Saposnik G, Biessels GJ et al (2017) Prevention of stroke in patients with silent cerebrovascular disease: a scientific statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 48:e44–e71. https://doi.org/10.1161/STR.0000000000000116
doi: 10.1161/STR.0000000000000116
pubmed: 27980126
Fanning JP, Wong AA, Fraser JF (2014) The epidemiology of silent brain infarction: a systematic review of population-based cohorts. BMC Med 12:119. https://doi.org/10.1186/s12916-014-0119-0
doi: 10.1186/s12916-014-0119-0
pubmed: 25012298
pmcid: 4226994
Debette S, Schilling S, Duperron MG, Larsson SC, Markus HS (2019) Clinical significance of magnetic resonance imaging markers of vascular brain injury: a systematic review and meta-analysis. JAMA Neurol 76:81–94. https://doi.org/10.1001/jamaneurol.2018.3122
doi: 10.1001/jamaneurol.2018.3122
pubmed: 30422209
Wright CB, Dong C, Perez EJ et al (2017) Subclinical cerebrovascular disease increases the risk of incident stroke and mortality: the Northern Manhattan Study. J Am Heart Assoc 6:e004069. https://doi.org/10.1161/JAHA.116.004069
doi: 10.1161/JAHA.116.004069
pubmed: 28847914
pmcid: 5634244
Andersen SD, Skjøth F, Yavarian Y, Bach FW, Lip GY, Larsen TB (2016) Multiple silent lacunes are associated with recurrent ischemic stroke. Cerebrovasc Dis 42:73–80. https://doi.org/10.1159/000445196
doi: 10.1159/000445196
pubmed: 27070721
Kang DW, Han MK, Kim HJ et al (2016) Silent new ischemic lesions after index stroke and the risk of future clinical recurrent stroke. Neurology 86:277–285. https://doi.org/10.1212/WNL.0000000000002289
doi: 10.1212/WNL.0000000000002289
pubmed: 26683639
pmcid: 4733153
Qu JF, Chen YK, Zhong HH, Li W, Lu ZH (2019) Preexisting cerebral abnormalities and functional outcomes after acute ischemic stroke. J Geriatr Psychiatry Neurol 32:327–335. https://doi.org/10.1177/0891988719862631
doi: 10.1177/0891988719862631
pubmed: 31480988
Elhfnawy AM, Volkmann J, Schliesser M, Fluri F (2019) Are cerebral white matter lesions related to the presence of bilateral internal carotid artery stenosis or to the length of stenosis among patients with ischemic cerebrovascular events? Front Neurol 10:919. https://doi.org/10.3389/fneur.2019.00919
doi: 10.3389/fneur.2019.00919
pubmed: 31555196
pmcid: 6727787
Finn C, Giambrone AE, Gialdini G et al (2017) The Association between carotid artery atherosclerosis and silent brain infarction: a systematic review and meta-analysis. J Stroke Cerebrovasc Dis 26:1594–1601. https://doi.org/10.1016/j.jstrokecerebrovasdis.2017.02.028
doi: 10.1016/j.jstrokecerebrovasdis.2017.02.028
pubmed: 28318958
pmcid: 5474126
Pini R, Faggioli G, Indelicato G et al (2020) Predictors and consequences of silent brain infarction in patients with asymptomatic carotid stenosis. J Stroke Cerebrovasc Dis 29:105108. https://doi.org/10.1016/j.jstrokecerebrovasdis.2020.105108
doi: 10.1016/j.jstrokecerebrovasdis.2020.105108
pubmed: 32912519
North American Symptomatic Carotid Endarterectomy Trial Collaborators (1991) Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. N Engl J Med 325:445–453. https://doi.org/10.1056/NEJM199108153250701
doi: 10.1056/NEJM199108153250701
Samuels OB, Joseph GJ, Lynn MJ, Smith HA, Chimowitz MI (2000) A standardized method for measuring intracranial arterial stenosis. AJNR Am J Neuroradiol 21:643–646
pubmed: 10782772
pmcid: 7976653
Zhang X, Ge Y, Liang C, Wang Y (2020) Cavitation of symptomatic acute single small subcortical infarctions. Neurol Sci 41:3705–3710. https://doi.org/10.1007/s10072-020-04509-z
doi: 10.1007/s10072-020-04509-z
pubmed: 32518995
Wardlaw JM, Smith EE, Biessels GJ et al (2013) Neuroimaging standards for research into small vessel disease and its contribution to ageing and neurodegeneration. Lancet Neurol 12:822–838. https://doi.org/10.1016/S1474-4422(13)70124-8
doi: 10.1016/S1474-4422(13)70124-8
pubmed: 23867200
pmcid: 3714437
King KS, Peshock RM, Warren MW et al (2013) Evaluation of a practical visual MRI rating scale of brain white matter hyperintensities for clinicians based on largest lesion size regardless of location. AJNR Am J Neuroradiol 34:797–801. https://doi.org/10.3174/ajnr.A3283
doi: 10.3174/ajnr.A3283
pubmed: 23079403
pmcid: 6486795
Ye H, Wu X, Yan J, Wang J, Qiu J, Wang Y (2019) Completeness of circle of Willis and white matter hyperintensities in patients with severe internal carotid artery stenosis. Neurol Sci 40:509–514. https://doi.org/10.1007/s10072-018-3683-9
doi: 10.1007/s10072-018-3683-9
pubmed: 30554353
Stroke prevention and control project committee, National health commission of the people’s Republic of China (2015) China guidelines for vascular ultrasound examination in stroke. Chin J Med Ultrasound (Electronic Edition) 12:599–610
Caplan LR, Hennerici M (1998) Impaired clearance of emboli (washout) is an important link between hypoperfusion, embolism, and ischemic stroke. Arch Neurol 55:1475–1482. https://doi.org/10.1001/archneur.55.11.1475
doi: 10.1001/archneur.55.11.1475
pubmed: 9823834
Madani A, Beletsky V, Tamayo A et al (2011) High-risk asymptomatic carotid stenosis: ulceration on 3D ultrasound vs TCD microemboli. Neurology 77:744–750. https://doi.org/10.1212/WNL.0b013e31822b0090
doi: 10.1212/WNL.0b013e31822b0090
pubmed: 21849642
Prabhakaran S, Rundek T, Ramas R et al (2006) Carotid plaque surface irregularity predicts ischemic stroke: the Northern Manhattan Study. Stroke 37:2696–2701. https://doi.org/10.1161/01.STR.0000244780.82190.a4
doi: 10.1161/01.STR.0000244780.82190.a4
pubmed: 17008627
pmcid: 2654324
Topakian R, King A, Kwon SU et al (2011) Ultrasonic plaque echolucency and emboli signals predict stroke in asymptomatic carotid stenosis. Neurology 77:751–758. https://doi.org/10.1212/WNL.0b013e31822b00a6
doi: 10.1212/WNL.0b013e31822b00a6
pubmed: 21849657
Huibers A, de Borst GJ, Bulbulia R et al (2016) Plaque echolucency and the risk of ischaemic stroke in patients with asymptomatic carotid stenosis within the first Asymptomatic Carotid Surgery Trial (ACST-1). Eur J Vasc Endovasc Surg 51:616–621. https://doi.org/10.1016/j.ejvs.2015.11.013
doi: 10.1016/j.ejvs.2015.11.013
pubmed: 26725253
El-Barghouty NM, Levine T, Ladva S et al (1996) Histological verification of computerised carotid plaque characterisation. Eur J Vasc Endovasc Surg 11:414–416. https://doi.org/10.1016/s1078-5884(96)80172-9
doi: 10.1016/s1078-5884(96)80172-9
pubmed: 8846173
Grønholdt ML, Nordestgaard BG, Wiebe BM et al (1998) Echo-lucency of computerized ultrasound images of carotid atherosclerotic plaques are associated with increased levels of triglyceride-rich lipoproteins as well as increased plaque lipid content. Circulation 97:34–40. https://doi.org/10.1161/01.cir.97.1.34
doi: 10.1161/01.cir.97.1.34
pubmed: 9443429
Porambo ME, DeMarco JK (2020) MR imaging of vulnerable carotid plaque. Cardiovasc Diagn Ther 10:1019–1031. https://doi.org/10.21037/cdt.2020.03.12
doi: 10.21037/cdt.2020.03.12
pubmed: 32968658
pmcid: 7487401
Park MS, Kwon S, Lee MJ et al (2019) Identification of high risk carotid artery stenosis: a multimodal vascular and perfusion imaging study. Front Neurol 10:765–752. https://doi.org/10.3389/fneur.2019.00765
doi: 10.3389/fneur.2019.00765
pubmed: 31379719
pmcid: 6647800
Baradaran H, Gialdini G, Mtui E, Askin G, Kamel H, Gupta A (2016) Silent brain infarction in patients with asymptomatic carotid artery atherosclerotic disease. Stroke 47:1368–1370. https://doi.org/10.1161/STROKEAHA.116.013193
doi: 10.1161/STROKEAHA.116.013193
pubmed: 27032443
Nah HW, Lee JW, Chung CH et al (2014) New brain infarcts on magnetic resonance imaging after coronary artery bypass graft surgery: lesion patterns, mechanism, and predictors. Ann Neurol 76:347–355. https://doi.org/10.1002/ana.24238
doi: 10.1002/ana.24238
pubmed: 25111072
Lam CK, Yoo T, Hiner B, Liu Z, Grutzendler J (2010) Embolus extravasation is an alternative mechanism for cerebral microvascular recanalization. Nature 465:478–482. https://doi.org/10.1038/nature09001
doi: 10.1038/nature09001
pubmed: 20505729
pmcid: 2879083
Gupta A, Kesavabhotla K, Baradaran H et al (2015) Plaque echolucency and stroke risk in asymptomatic carotid stenosis. A systematic review and meta-analysis Stroke 46:91–97. https://doi.org/10.1161/STROKEAHA.114.006091
doi: 10.1161/STROKEAHA.114.006091
pubmed: 25406150
Zarrinkoob L, Wåhlin A, Ambarki K, Birgander R, Eklund A, Malm J (2019) Blood flow lateralization and collateral compensatory mechanisms in patients with carotid artery stenosis. Stroke 50:1081–1088. https://doi.org/10.1161/STROKEAHA.119.024757
doi: 10.1161/STROKEAHA.119.024757
pubmed: 30943887
pmcid: 6485302
Rosenson RS, Brewer HB Jr, Ansell BJ et al (2016) Dysfunctional HDL and atherosclerotic cardiovascular disease. Nat Rev Cardiol 13:48–60. https://doi.org/10.1038/nrcardio.2015.124
doi: 10.1038/nrcardio.2015.124
pubmed: 26323267
Tran-Dinh A, Diallo D, Delbosc S et al (2013) HDL and endothelial protection. Br J Pharmacol 169:493–511. https://doi.org/10.1111/bph.12174
doi: 10.1111/bph.12174
pubmed: 23488589
pmcid: 3682699
Wang H, Zhang X, Yu B et al (2019) Cyclodextrin ameliorates the progression of atherosclerosis via increasing high-density lipoprotein cholesterol plasma levels and anti-inflammatory effects in rabbits. J Cardiovasc Pharmacol 73:334–342. https://doi.org/10.1097/FJC.0000000000000660
doi: 10.1097/FJC.0000000000000660
pubmed: 30855405
Chen J, Zhang X, Millican R, Creutzmann JE, Martin S, Jun HW (2020) High density lipoprotein mimicking nanoparticles for atherosclerosis. Nano Converg 7:6. https://doi.org/10.1186/s40580-019-0214-1
doi: 10.1186/s40580-019-0214-1
pubmed: 31984429
pmcid: 6983461
Ye H, Wang Y, Qiu J, Wu Q, Xu M, Wang J (2018) White matter hyperintensities and their subtypes in patients with carotid artery stenosis: a systematic review and meta-analysis. BMJ Open 8:e020830. https://doi.org/10.1136/bmjopen-2017-020830
doi: 10.1136/bmjopen-2017-020830
pubmed: 29769255
pmcid: 5961568
Ryu WS, Schellingerhout D, Ahn HS et al (2018) Hemispheric asymmetry of white matter hyperintensity in association with lacunar infarction. J Am Heart Assoc 7:e010653. https://doi.org/10.1161/JAHA.118.010653
doi: 10.1161/JAHA.118.010653
pubmed: 30571500
pmcid: 6404451