Department of Medicine and Therapeutics, Chinese University of Hong Kong, Hong Kong SAR, China.
Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
Eur Stroke J. 2024 Mar;9(1):144-153. doi: 10.1177/23969873231205669. Epub 2023 Oct 6.
Cerebral small vessel disease (CSVD) commonly exists in patients with symptomatic intracranial atherosclerotic disease (sICAD). We aimed to investigate the associations of hemodynamic features of sICAD lesions with imaging markers and overall burden of CSVD.
Patients with anterior-circulation sICAD (50%-99% stenosis) were analyzed in this cross-sectional study. Hemodynamic features of a sICAD lesion were quantified by translesional pressure ratio (PR = Pressure/Pressure) and wall shear stress ratio (WSSR = WSS/WSS) via CT angiography-based computational fluid dynamics modeling. PR ⩽median was defined as low ("abnormal") PR, and WSSR ⩾ fourth quartile as high ("abnormal") WSSR. For primary analyses, white matter hyperintensities (WMHs), lacunes, and cortical microinfarcts (CMIs) were assessed in MRI and summed up as overall CSVD burden, respectively in ipsilateral and contralateral hemispheres to sICAD. Enlarged perivascular spaces (EPVSs) and cerebral microbleeds (CMBs) were assessed for secondary analyses.
Among 112 sICAD patients, there were more severe WMHs, more lacunes and CMIs, and more severe overall CSVD burden ipsilaterally than contralaterally (all < 0.05). Abnormal PR and WSSR (vs normal PR and WSSR) was significantly associated with moderate-to-severe WMHs (adjusted odds ratio = 10.12, = 0.018), CMI presence (5.25, = 0.003), and moderate-to-severe CSVD burden (12.55; = 0.033), ipsilaterally, respectively independent of contralateral WMHs, CMI(s), and CSVD burden. EPVSs and CMBs were comparable between the two hemispheres, with no association found with the hemodynamic metrics.
There are more severe WMHs and CMI(s) in the hemisphere ipsilateral than contralateral to sICAD. The hemodynamic significance of sICAD lesions was independently associated with severities of WMHs and CMI(s) ipsilaterally.
脑小血管病（CSVD）常见于症状性颅内动脉粥样硬化性疾病（sICAD）患者。我们旨在研究 sICAD 病变的血流动力学特征与影像学标志物和 CSVD 总体负担的关系。
本横断面研究分析了前循环 sICAD（50%-99%狭窄）患者。通过基于 CT 血管造影的计算流体动力学模型，量化 sICAD 病变的血流动力学特征，包括跨病变压力比（PR=压力/压力）和壁面切应力比（WSSR=WSS/WSS）。PR ⩽中位数定义为低（“异常”）PR，WSSR ⩾四分位距定义为高（“异常”）WSSR。对于主要分析，在 MRI 上评估白质高信号（WMHs）、腔隙和皮质微梗死（CMIs），并分别将同侧和对侧半球的总体 CSVD 负担相加。为了进行二次分析，评估了扩大的血管周围间隙（EPVSs）和脑微出血（CMBs）。
在 112 例 sICAD 患者中，同侧的 WMHs 更严重，腔隙和 CMIs 更多，总体 CSVD 负担也更严重（均 < 0.05）。异常 PR 和 WSSR（与正常 PR 和 WSSR 相比）与中度至重度 WMHs（调整后的优势比=10.12，=0.018）、CMI 存在（5.25，=0.003）和中度至重度 CSVD 负担（12.55，=0.033）独立相关，分别为同侧，且不受对侧 WMHs、CMI 和 CSVD 负担的影响。EPVSs 和 CMBs 在两侧半球之间无差异，与血流动力学指标无关联。
sICAD 对侧半球的 WMHs 和 CMI（s）比同侧更严重。sICAD 病变的血流动力学意义与同侧 WMHs 和 CMI（s）的严重程度独立相关。
