Correlation Study Between Intracranial Arterial Dolichoectasia And Total Cerebral Small Vessel Disease Burden In Patients With Acute Mild Cerebral Infarction

Objective To investigate the retionship between intracranial arterial dolichoectasia(IADE)and the total cerebral small vessel disease(CSVD)burden of arteriolar sclerosis in patients with acute mild cerebral infarction.Methods Patients with acute mild cerebral infarction who were hospitalized in the Department of Neurology of Changzhou Second People’s Hospital from April 2021 to October 2021 were included consecutively.Baseline data of patients were collected,including age,gender,hypertension,diabetes,previous stroke history,coronary heart disease,smoking history,systolic blood pressure,diastolic blood pressure,fasting blood glucose,serum creatinine,glycosylated hemoglobin,blood lipids(total cholesterol,triglycerides,high density lipoprotein,low density lipoprotein),blood homocysteine,etc.All patients underwent cerebral MRI and CTA examination,CTA and MRI were used to measure the diameter of cavernous sinus segment of internal carotid artery,diameter of M1 segment of middle cerebral artery,diameter of anterior cerebral artery,diameter of basilar artery,bifurcation height of basilar artery and lateral displacement of basilar artery to diagnose IADE,including the intracranial dolichoectasic carotid and middle cerebral artery(ICDA)and vertebrobasilar dolichoectasia(VBD).Four imaging markers including lacunar infarcts(LIs),enlarge perivascular spaces(EPVS),cerebral microbleeds(CMBs)and white matter hyperintensities(WMHs)were evaluated by MRI and the total CSVD score was measured.Patients with acute mild cerebral infarction were divided into IADE group and non IADE group according to whether they had IADE or not.According to the CSVD total load score,0-1 points was included in the no-mild CSVD total burden groupand 2-4 points was included in the moderate-severe CSVD total burden group.The baseline and imaging data of each group were compared,and the relationship between IADE and CSVD total burden was further analyzed by multivariate Logistic regression.CTA was used to measure the diameter of seven arteries,and z-score was obtained by standardized Z-conversion of each artery diameter.Then,the z-score of each individual was added and divided by the total number of arteries to obtain the average Z-score of each individual,also known as brain arterial remodeling score(BAR score).Spearman correlation analysis was used to further explore the correlation between BAR score and CSVD total burden.Results(1)A total of 290 patients were enrolled,including 41 IADE patients and249 non-IADE patients.There were 189 patients with no-mild burden of CSVD and 101 patients with moderate to severe burden of CSVD.(2)Age([72±10] years vs.[66±12]years,t=-3.440),male proportion(85.4% [35/41] vs.69.5% [173/249],χ~2=4.382),LIs(48.8% [20/41] vs.28.5%,[71/249],χ~2=6.715),BG-EPVS(χ~2=7.596),burden of CSVD(χ~2=34.989)and WMHs score(4[3,5] score vs.2[1,4] score,Z=-4.053)in IADE group patients were higher than in non-IADE group patients,the differences were statistically significant(all P < 0.05).(3)Further according to the total burden of different degrees of CSVD comparison found that age([70±11] years vs.[65±12] years,Z=-3.460),male proportion(79.2% [80/101] vs.67.7%[128/189],χ~2=4.280),past history of stroke(38.6%[39/101] vs.23.3%[44/189],χ~2=7.576),serum creatinine level(73.00[63.30,84.00]μmol/Lvs.67.00[58.40,79.00]μmol/L,Z=2.250),homocysteine(13.00[10.00,17.50])μmol/Lvs.11.40[9.10,15.05]μmol/L,Z=-2.590),use of antiplatelet aggregations drugs(26.7% [27/101] vs.12.2% [23/189],χ~2=9.784)and lipid-lowering drugs(21.8%[22/101] vs.12.2% [23/189],χ~2=4.640)before admission,proportion of IADE(30.7%[31/101] vs.5.3% [10/189],χ~2=34.989)and BAR score(0.60[0.22,1.07] vs.-0.34[-0.58,0.83],Z=-9.632)in moderate to severe burden of CSVD group were higher than in no-mild CSVD total burden group,the differences were statistically significant(all P<0.05).(4)Spearman correlation analysis found that basilar artery diameter was positively correlated with total CSVD burden(r=0.567,P<0.01).(5)Multivariate binary Logistic regression analysis indicated that IADE(OR=5.950,95% CI2.678-13.222,P<0.01)and age(OR=1.030,95%CI1.005-1.056,P=0.020)was independent influencing factors for moderate to severe burden of CSVD in arteriolar sclerosis.Conclusion In patients with acute mild cerebral infarction,IADE was an independent risk factor for moderate to severe CSVD total burden with arteriolar sclerosis.