Stoisavljevic Stefan, Zdraljevic Mirjana, Radojicic Aleksandra, Pavlovic Aleksandra, Mijajlovic Milija
Faculty of Medicine University of Belgrade, 11000, Belgrade, Serbia.
Neurology Clinic, University Clinical Center of Serbia, 11000, Belgrade, Serbia.
Heliyon. 2024 Aug 13;10(16):e36052. doi: 10.1016/j.heliyon.2024.e36052. eCollection 2024 Aug 30.
Cerebral small vessel disease (CSVD) encompasses conditions that affect small blood vessels of the brain, the most common being atherosclerosis. Magnetic resonance imaging (MRI) CSVD markers include lacunar strokes (LS), white matter hyperintensities (WMH), microbleeds, enlarged perivascular spaces (EPVS), and brain atrophy. Large and small cerebral arteries share an anatomical and functional connection, but the role of large vessel atherosclerosis in atherosclerotic CSVD hasn't been established. The aim of this study was to evaluate the involvement of large vessel pathology in atherosclerotic CSVD.
This cross-sectional study included 98 patients treated at the Neurology Clinic of the University Clinical Center of Serbia in Belgrade, from February 2018 to December 2023, who had atherosclerotic CSVD confirmed by neuroimaging and underwent extracranial color duplex sonography. Data on patients' gender, age, cerebrovascular risk factors (dyslipidemia, hypertension, diabetes mellitus, smoking status), ultrasonography findings (intima-media thickness - IMT, carotid and vertebral artery stenosis, and hemodynamics), and CSVD imaging markers were collected, and the CSVD MRI burden score was calculated.
Age correlated with LS and WMH (p < 0.05 for both). Hypertension correlated with WMH (p = 0.016), and smoking with LS (p = 0.043). Brain atrophy was more common in women (p = 0.016). The majority of patients had low-grade (<50 %) carotid stenosis. There was a strong correlation between all morphological parameters of internal carotid artery stenosis and the CSVD burden score (p < 0.05 for all). The hemodynamic parameters of internal carotid artery stenosis and morphological and hemodynamic parameters of vertebral artery stenosis didn't correlate with the CSVD burden score.
This study shows a strong correlation between cerebral large and small vessel pathology. We recommend the use of extracranial color duplex sonography in the evaluation of patients with CSVD as a supplementary method for follow-up, as this would allow the identification of patients whose condition might progress.
脑小血管病（CSVD）包括影响脑小血管的病症，最常见的是动脉粥样硬化。磁共振成像（MRI）CSVD标志物包括腔隙性脑梗死（LS）、白质高信号（WMH）、微出血、血管周围间隙扩大（EPVS）和脑萎缩。大脑的大、小动脉在解剖学和功能上存在联系，但大血管动脉粥样硬化在动脉粥样硬化性CSVD中的作用尚未明确。本研究的目的是评估大血管病变在动脉粥样硬化性CSVD中的参与情况。
这项横断面研究纳入了2018年2月至2023年12月在贝尔格莱德塞尔维亚大学临床中心神经科门诊接受治疗的98例患者，这些患者经神经影像学证实患有动脉粥样硬化性CSVD，并接受了颅外彩色双功超声检查。收集患者的性别、年龄、脑血管危险因素（血脂异常、高血压、糖尿病、吸烟状况）、超声检查结果（内膜中层厚度 - IMT、颈动脉和椎动脉狭窄及血流动力学）以及CSVD成像标志物的数据，并计算CSVD MRI负担评分。
年龄与LS和WMH相关（两者p < 0.05）。高血压与WMH相关（p = 0.016），吸烟与LS相关（p = 0.043）。脑萎缩在女性中更常见（p = 0.016）。大多数患者有低度（<50%）颈动脉狭窄。颈内动脉狭窄的所有形态学参数与CSVD负担评分之间存在强相关性（所有p < 0.05）。颈内动脉狭窄的血流动力学参数以及椎动脉狭窄的形态学和血流动力学参数与CSVD负担评分无关。
本研究表明脑大血管和小血管病变之间存在强相关性。我们建议在CSVD患者评估中使用颅外彩色双功超声作为随访的辅助方法，因为这将有助于识别病情可能进展的患者。
