School of Medicine, 27890Universidad Espíritu Santo - Ecuador, Samborondón, Ecuador.
Department of Epidemiology, 2158Gilead Sciences, Inc., Foster City, CA, USA.
Neuroradiol J. 2022 Oct;35(5):607-611. doi: 10.1177/19714009221083147. Epub 2022 Apr 4.
Lacunes of presumed vascular origin are perceived as biomarkers of cerebral small vessel disease (cSVD), although they may also be related to other pathogenetic mechanisms. We aimed to assess whether lacunes are more often associated with intracranial artery stenosis (IAS) than with white matter hyperintensities (WMH) of presumed vascular origin (a biomarker of cSVD) in older adults.
This study included 585 individuals aged ≥60 years living in rural Ecuador. Logistic regression models were fitted to assess the strength of the association between IAS or moderate-to-severe WHM on one side, and lacunes on the other. Mediation analysis was used to estimate the percentage of the effect of IAS on lacunes that was mediated by WMH.
Lacunes were noticed in 62 (11%) individuals, IAS in 39 (7%), and moderate-to-severe WMH in 169 (29%). Fourteen of 39 individuals (36%) with IAS had lacunes, which corresponded to the territory of the stenotic artery in 50% of cases. Lacunes have a larger association with IAS than with moderate-to-severe WMH. The estimated prevalence rate of lacunes independently of any confounder was 10.6% (95% C.I.: 8.3-12.9%), which increased to 22.2% in subjects with IAS, but only to 16.4% among those with moderate-to-severe WMH. Only 24.5% of the effect of IAS on lacunes was mediated by WMH.
Lacunes are more often associated with IAS than with WMH at the population level. Neuroimaging investigation of the intracranial vasculature in individuals with lacunes will provide informed-based decisions for secondary stroke prevention.
由血管原因导致的腔隙被认为是脑小血管疾病（cSVD）的生物标志物，尽管它们也可能与其他发病机制有关。我们旨在评估在老年人中，腔隙是否比由血管原因引起的脑白质高信号（WMH）（cSVD 的生物标志物）更常与颅内动脉狭窄（IAS）相关。
本研究纳入了居住在厄瓜多尔农村地区的 585 名年龄≥60 岁的个体。采用逻辑回归模型评估 IAS 或单侧中度至重度 WMH 与另一侧腔隙之间关联的强度。采用中介分析估计 IAS 对腔隙的影响中有多少是由 WMH 介导的。
62 名（11%）个体有腔隙，39 名（7%）有 IAS，169 名（29%）有中度至重度 WMH。39 名有 IAS 的个体中有 14 名（36%）有腔隙，其中 50%的腔隙对应狭窄动脉的供血区。腔隙与 IAS 的相关性大于与中度至重度 WMH 的相关性。在不考虑任何混杂因素的情况下，腔隙的估计患病率为 10.6%（95%CI：8.3-12.9%），在有 IAS 的患者中增加至 22.2%，而在有中度至重度 WMH 的患者中仅增加至 16.4%。IAS 对腔隙的影响仅有 24.5%是由 WMH 介导的。
在人群水平上，腔隙与 IAS 的相关性大于与 WMH 的相关性。对有腔隙的个体进行颅内血管神经影像学检查将为二级卒中预防提供基于证据的决策。
