Song Tae-Jin, Kim Young Dae, Yoo Joonsang, Kim Jinkwon, Chang Hyuk-Jae, Hong Geu Ru, Shim Chi Young, Song Dongbeom, Heo Ji Hoe, Nam Hyo Suk
Department of Neurology, Ewha Womans University College of Medicine, Seoul, Korea.
Department of Neurology, Yonsei University College of Medicine, Seoul, Korea.
J Stroke. 2016 Sep;18(3):312-320. doi: 10.5853/jos.2016.00171. Epub 2016 Aug 4.
Cerebral small vessel disease (SVDs) are related with large artery atherosclerosis. However, the association between aortic atheroma (AA) and cerebral small vessel disease has rarely been reported. This study evaluated the relationship between presence and burden of AAs and those of SVDs in patients with acute ischemic stroke.
We included 737 consecutive patients who underwent transesophageal echocardiography (TEE) and brain magnetic resonance imaging (MRI) for evaluation of acute stroke. AA subtypes were classified as complex aortic plaque (CAP) and simple aortic plaque (SAP). Presence and burden of SVDs including cerebral microbleeds (CMBs), white matter hyperintensities (WMHs), perivascular spaces (PVSs), asymptomatic lacunar infarctions (ALIs), and total SVD score, were investigated.
AA was found by TEE in 360 (48.8%) patients including 11.6% with CAP and 37.2% with SAP. One or more types of SVDs was found in 269 (36.4%) patients. In multivariable analysis, presence of CMBs (odds ratio [OR] 4.68), high-grade WMHs (OR 3.13), high-grade PVSs (OR 3.35), and ALIs (OR 4.24) were frequent in patients with AA than those without AA. Each 1-point increase in total SVD score increased the odds of presence of CAP (OR 1.94, 95% confidence interval (CI) 1.44-1.85) and SAP (OR 1.54, 95% CI 1.35-1.75).
In this study, patients with AA frequently had cerebral SVDs. Larger burden of AA was associated with advanced cerebral SVDs. Our findings give an additional information for positive relationship with systemic atherosclerosis and coexisting cerebral SVDs in acute ischemic stroke patients.
脑小血管病（SVDs）与大动脉粥样硬化有关。然而，主动脉粥样硬化（AA）与脑小血管病之间的关联鲜有报道。本研究评估了急性缺血性脑卒中患者中AA的存在及负荷与SVDs的存在及负荷之间的关系。
我们纳入了737例连续接受经食管超声心动图（TEE）和脑磁共振成像（MRI）以评估急性脑卒中的患者。AA亚型分为复杂主动脉斑块（CAP）和简单主动脉斑块（SAP）。研究了包括脑微出血（CMBs）、白质高信号（WMHs）、血管周围间隙（PVSs）、无症状腔隙性梗死（ALIs）以及总SVD评分在内的SVDs的存在及负荷情况。
通过TEE在360例（48.8%）患者中发现了AA，其中11.6%为CAP，37.2%为SAP。在269例（36.4%）患者中发现了一种或多种类型的SVDs。在多变量分析中，与无AA的患者相比，有AA的患者中CMBs（优势比[OR]4.68）、高级别WMHs（OR 3.13）、高级别PVSs（OR 3.35）和ALIs（OR 4.24）更为常见。总SVD评分每增加1分，CAP（OR 1.94，95%置信区间[CI]1.44 - 1.85）和SAP（OR 1.54，95%CI 1.35 - 1.75）存在的几率增加。
在本研究中，有AA的患者经常患有脑SVDs。AA的较大负荷与晚期脑SVDs相关。我们的研究结果为急性缺血性脑卒中患者全身动脉粥样硬化与并存的脑SVDs之间的正相关关系提供了额外信息。
