Department of Neurology, Ankara Dışkapı Yıldırım Beyazıt Training and Research Hospital, University of Health Sciences, Çiğdem mah. 1550/1 cad. 23/1 Çankaya, Ankara, Turkey.
Department of Radiology, Ankara Dışkapı Yıldırım Beyazıt Training and Research Hospital, University of Health Sciences, Ankara, Turkey.
Acta Neurol Belg. 2021 Aug;121(4):983-991. doi: 10.1007/s13760-020-01517-w. Epub 2020 Oct 9.
The association of carotid atherosclerosis with silent brain infarcts (SBIs) and white matter lesions (WMLs) currently remains unknown. This study aims to compare SBIs, deep white matter lesions (DWMLs), and periventricular white matter lesions (PWMLs) in ipsilateral and contralateral hemispheres to internal carotid artery (ICA) stenosis, and investigate their association with stenosis grade in patients with asymptomatic ≥ 50% unilateral extracranial ICA stenosis. Patients without previous history of stroke and/or transient ischemic attack who had ≥ 50% stenosis in unilateral ICA on carotid color Doppler ultrasound were enrolled in the study. Patient demographics, vascular risk factors and ICA stenosis grades; number, location, and size of SBIs, DWMLs, and PWMLs in ICA territory were evaluated in both hemispheres using magnetic resonance imaging of the brain. Of the 69 patients, 53 had 50-69% (76.8%) and 16 had ≥ 70% (23.2%) unilateral ICA stenosis. There was no statistically significant difference in SBIs between ipsilateral and contralateral hemispheres to ≥ 50% ICA stenosis. Comparison of ICA stenoses as 50-69% and ≥ 70% revealed a greater number of patients with SBI in ipsilateral hemisphere to ≥ 70% stenosis compared to contralateral (p = 0.025). The number of SBIs was also higher in ipsilateral hemisphere to ≥ 70% stenosis compared to contralateral (p = 0.022). While DWMLs and PWMLs did not differ between hemispheres, frequency of Fazekas grade 1 DWMLs was lower in ipsilateral hemisphere to either 50-69% or ≥ 70% ICA stenosis compared to contralateral (p = 0.035 and p = 0.025, respectively). Results of the present study indicate that stenosis grade may be relevant in the association between asymptomatic carotid stenosis and SBIs, and ≥ 70% stenosis may pose a risk of SBI development.
目前，颈动脉粥样硬化与无症状性脑梗死（SBI）和脑白质病变（WML）之间的关联尚不清楚。本研究旨在比较同侧和对侧颈内动脉（ICA）狭窄患者的 SBI、深部脑白质病变（DWML）和脑室周围脑白质病变（PWML），并探讨它们与无症状性单侧颅外 ICA 狭窄≥50%患者狭窄程度的关系。这项研究纳入了经颈动脉彩色多普勒超声检查发现单侧 ICA 狭窄≥50%且无卒中或短暂性脑缺血发作病史的患者。评估了患者的人口统计学特征、血管危险因素和 ICA 狭窄程度；使用脑部磁共振成像评估了双侧 ICA 区域的 SBI、DWML 和 PWML 的数量、位置和大小。在 69 名患者中，53 名患者的 ICA 狭窄程度为 50-69%（76.8%），16 名患者的 ICA 狭窄程度≥70%（23.2%）。同侧和对侧 ICA 狭窄≥50%的 SBI 之间无统计学差异。同侧和对侧 ICA 狭窄程度分别为 50-69%和≥70%的比较显示，同侧 ICA 狭窄程度≥70%的患者 SBI 数量多于对侧（p=0.025）。同侧 ICA 狭窄程度≥70%的 SBI 数量也多于对侧（p=0.022）。虽然 DWML 和 PWML 之间在两侧无差异，但同侧 ICA 狭窄程度为 50-69%或≥70%的患者中，DWML 为 Fazekas 1 级的频率低于对侧（p=0.035 和 p=0.025）。本研究结果表明，狭窄程度可能与无症状性颈动脉狭窄和 SBI 之间存在关联，而≥70%的狭窄可能增加 SBI 发生的风险。
