Department of Neurology, Mayo Clinic, Jacksonville, FL.
Department of Radiology, Mayo Clinic, Jacksonville, FL.
J Stroke Cerebrovasc Dis. 2023 Sep;32(9):107287. doi: 10.1016/j.jstrokecerebrovasdis.2023.107287. Epub 2023 Jul 31.
Carotid stenosis may cause silent cerebrovascular disease (CVD) through atheroembolism and hypoperfusion. If so, revascularization may slow progression of silent CVD. We aimed to compare the presence and severity of silent CVD to the degree of carotid bifurcation stenosis by cerebral hemisphere.
Patients age ≥40 years with carotid stenosis >50% by carotid ultrasound who underwent MRI brain from 2011-2015 at Mayo Clinic were included. Severity of carotid stenosis was classified by carotid duplex ultrasound as 50-69% (moderate), 70-99% (severe), or occluded. White matter lesion (WML) volume was quantified using an automated deep-learning algorithm applied to axial T2 FLAIR images. Differences in WML volume and prevalent silent infarcts were compared across hemispheres and severity of carotid stenosis.
Of the 183 patients, mean age was 71±10 years, and 39.3% were female. Moderate stenosis was present in 35.5%, severe stenosis in 46.5% and occlusion in 18.0%. Patients with carotid stenosis had greater WML volume ipsilateral to the side of carotid stenosis than the contralateral side (mean difference, 0.42±0.21cc, p=0.046). Higher degrees of stenosis were associated with greater hemispheric difference in WML volume (moderate vs. severe; 0.16±0.27cc vs 0.74±0.31cc, p=0.009). Prevalence of silent infarct was 23.5% and was greater on the side of carotid stenosis than the contralateral side (hemispheric difference 8.8%±3.2%, p=0.006). Higher degrees of stenosis were associated with higher burden of silent infarcts (moderate vs severe, 10.8% vs 31.8%; p=0.002).
WML and silent infarcts were greater on the side of severe carotid stenosis.
颈动脉狭窄可通过动脉粥样硬化栓子和低灌注导致无症状性脑血管疾病（CVD）。如果是这样，血管重建可能会减缓无症状性 CVD 的进展。我们旨在通过大脑半球比较无症状性 CVD 的存在和严重程度与颈动脉分叉狭窄程度的关系。
本研究纳入了 2011 年至 2015 年在梅奥诊所接受颈动脉超声检查且颈动脉狭窄>50%的年龄≥40 岁的患者。颈动脉狭窄程度通过颈动脉双功能超声分为 50-69%（中度）、70-99%（重度）或闭塞。使用应用于轴向 T2 FLAIR 图像的自动深度学习算法对脑白质病变（WML）体积进行定量。比较了不同半球和颈动脉狭窄程度之间 WML 体积和无症状性梗死的差异。
在 183 例患者中，平均年龄为 71±10 岁，39.3%为女性。中度狭窄占 35.5%，重度狭窄占 46.5%，闭塞占 18.0%。颈动脉狭窄患者的 WML 体积在狭窄侧大于对侧（平均差异，0.42±0.21cc，p=0.046）。较高程度的狭窄与 WML 体积的半球差异更大相关（中度与重度；0.16±0.27cc 与 0.74±0.31cc，p=0.009）。无症状性梗死的患病率为 23.5%，且在颈动脉狭窄侧高于对侧（半球差异 8.8%±3.2%，p=0.006）。较高程度的狭窄与无症状性梗死的负担更大相关（中度与重度，10.8%与 31.8%；p=0.002）。
严重颈动脉狭窄侧的 WML 和无症状性梗死更严重。
