Department of Radiology, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands.
Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands.
Cerebrovasc Dis. 2023;52(2):226-233. doi: 10.1159/000526261. Epub 2022 Sep 12.
It has been hypothesized that carotid artery stenosis (CAS) may lead to greater atrophy of subserved brain regions; however, prospective studies on the impact of CAS on progression of hemispheric brain atrophy are lacking. We examined the association between CAS and progression of hemispheric brain atrophy.
We included 654 patients (57 ± 9 years) of the SMART-MR study, a prospective cohort study of patients with manifest arterial disease. Patients had baseline CAS duplex measurements and a 1.5T brain MRI at baseline and after 4 years of follow-up. Mean change in hemispheric brain volumes (% of intracranial volume [ICV]) was estimated between baseline and follow-up for left-sided and right-sided CAS across three degrees of stenosis (mild [≤29%], moderate [30-69%], and severe [≥70%]), adjusting for demographics, cerebrovascular risk factors, and brain infarcts.
Mean decrease in left and right hemispheric brain volumes was 1.15% ICV and 0.82% ICV, respectively, over 4 years of follow-up. Severe right-sided CAS, compared to mild CAS, was associated with a greater decrease in volume of the left hemisphere (B = -0.49% ICV, 95% CI: -0.86 to -0.13) and more profoundly of the right hemisphere (B = -0.90% ICV, 95% CI: -1.27 to -0.54). This pattern was independent of cerebrovascular risk factors, brain infarcts, and white matter hyperintensities on MRI, and was also observed when accounting for the presence of severe bilateral CAS. Increasing degrees of left-sided CAS, however, was not associated with greater volume loss of the left or right hemisphere.
Our data indicate that severe (≥70%) CAS could represent a risk factor for greater ipsilateral brain volume loss, independent of cerebrovascular risk factors, brain infarcts, or white matter hyperintensities on MRI. Further longitudinal studies in other cohorts are warranted to confirm this novel finding.
有人假设颈动脉狭窄（CAS）可能导致受支配脑区的更大萎缩；然而，关于 CAS 对大脑半球萎缩进展的影响的前瞻性研究尚缺乏。我们研究了 CAS 与大脑半球萎缩进展之间的关联。
我们纳入了 SMART-MR 研究的 654 名患者（57±9 岁），这是一项针对有症状动脉疾病患者的前瞻性队列研究。患者在基线时有 CAS 双功能超声检查和 1.5T 脑 MRI，随访 4 年后再次进行 MRI。根据狭窄程度（轻度[≤29%]、中度[30-69%]和重度[≥70%]），分别对左、右侧 CAS 患者的脑体积（颅内体积[ICV]的百分比）的基线和随访之间的平均变化进行估计，调整了人口统计学、脑血管危险因素和脑梗死。
在 4 年的随访中，左、右大脑半球的体积平均分别减少了 1.15%ICV 和 0.82%ICV。与轻度 CAS 相比，严重右侧 CAS 与左半球体积减少（B=-0.49%ICV，95%CI：-0.86 至-0.13）和右半球体积减少（B=-0.90%ICV，95%CI：-1.27 至-0.54）幅度更大相关。这种模式独立于脑血管危险因素、脑梗死和 MRI 上的脑白质高信号，在考虑到严重双侧 CAS 存在的情况下也观察到了这种模式。然而，左侧 CAS 程度的增加与左或右半球的体积丢失无关。
我们的数据表明，严重（≥70%）CAS 可能是同侧脑体积丢失更大的一个危险因素，与脑血管危险因素、脑梗死或 MRI 上的脑白质高信号无关。需要进一步在其他队列中进行纵向研究来证实这一新发现。
