Correlatioual Study On Cerebralmicrobleeds And Caroticd Atherosclerosis And White Matter Lesions In Patients With Ischemic Stroke

Background:Ischemic stroke is the leading cause of disability in adults worldwide and the second most common cause of death.Epidemiological evidence indicates that the incidence of first stroke is reduced after controlling for stroke risk factors.Cerebral microbleeds(CMBs)are a type of cerebrovascular disease that involve cerebral microvascular leakage or rupture,leading to perivascular deposition of hemosiderin and ferritin,thereby damaging the brain parenchyma.They are more commonly found in the cortex-subcortex and deep brain structures,such as the thalamus,brainstem,and basal ganglia.One hypothesis on the mechanisms for the pathogenesis of CMBs is atherosclerosis(AS).The collateral compensation in neovascularization may be an important pathway for AS or arterial stenosis leading to CMBs.Patients with AS have a higher incidence of CMBs,and AS and CMBs have common risk factors such as hypertension,diabetes,and age.As carotid lesions precede lesions in coronary and intracranial arteries,carotid arteries serve as windows for the occurrence of systemic AS.However,the relationship between CMBs and carotid atherosclerosis has rarely been reported.This study aims to provide more clinical evidence for the prevention of CMBs in patients with ischemic stroke by analyzing the relationship between CMBs and carotid atherosclerosis in patients with ischemic stroke.Purpose:Cerebral microbleeds(CMBs)are a type of cerebral small vessel disease,and the association between CMBs and carotid atherosclerosis in patients with ischemic stroke remains unclear.This study aimed to investigate the correlation between cerebral microbleeds and carotid atherosclerosis in patients with ischemic stroke.Methods:Patients with ischemic stroke treated in a hospital in China from 2016 to 2017 were enrolled.A total of 198 patients were enrolled.All patients underwent SWI(susceptibility weighted imaging)and carotid ultrasound examination.According to the results of SWIs patients were divided into the CMBs group(91 cases)and the non-CMBs group(107 cases);According to the severity of CMBs,the patients were divided into Grades 0-3,grade 0:no CMBs lesions,grade 1:1-5 lesions,grade 2:6-10 lesions,grade 3:>10 lesions;In the CMBs group,patients were further subdivided according to lesion site into the lobar group,deep brain(basal ganglia,thalamus),/infratentorial(brainstem,cerebellum)group.A color Doppler ultrasound system(Aplio XG SSA-790A;Toshiba Medical Systems Corporation,Japan)was used to assess carotid AS,including carotid intima-media thickness(CIMT),plaque Crouse score,carotid plaque echo and carotid elasticity index(??Ep.DC).CIMT:1.0 mm was considered to be normal;1.0-1.2 mm,thickened;and ?1.2 mm,formation of atherosclerotic plaques.According to the echo characteristics of plaque,it is divided into hypoechoic plaque,iso-echo plaque,strong echo plaque,and mixed echo plaque.Details of patients'demographic information(gender,age),cerebrovascular disease-related risk factors(history of hypertension,history of diabetes,history of coronary heart disease,history of hyperlipidemia,history of smoking,history of drinking),laboratory indicators(same type Cystine,high-sensitivity C-reactive protein,high-density lipoprotein,low-density lipoprotein),history of antithrombotic drug use,baseline systolic blood pressure,baseline diastolic blood pressure,carotid atherosclerosis indices(CIMT,Crouse score),cerebral microbleed distribution,and grading were recorded.We analyze relationship between CMBs and carotid atherosclerosis.Results:Among the 198 patients enrolled,91 patients with CMBs were included in the CMBs group and 107 patients without CMBs in the non-CMBs group.The common sites of CMBs were deep brain/infratentorial group(76.90%),lobar group(23.10%).Univariate analysis showed that age,systolic blood pressure,homocysteine(HCY),high-sensitivity C-reactive protein(hs-CRP),history of hypertension,history of antithrombotic use,and carotid AS detection rate were significantly different between CMBs group and the non-CMBs group(P<0.05).As the severity of CMBs increased,the carotid AS indices,including CIMT value(P<0.05)and Crouse score(P<0.001),also increased.A statistically significant difference was noted among the different grades.The values of carotid elasticity index ? and Ep were higher in CMBs group than in non-CMBs group(P<0.001),and increased with the severity of CMBs(P<0.05);DC values were higher in non-CMBs group(P<0.001)and decreased as the severity of CMBs increased(P<0.05).In the distribution of cerebral microbleed sites,Crouse scores of the deep brain/infratentorial group were higher than the lobar group and showed a statistically significant difference(P<0.05).As the degree of carotid atherosclerosis increased,the average number of cerebral microbleeds also increased(P<0.001).The detection rate of low echo plaque in the CMBs group was higher than that in the non-CMBs group(P<0.05).There were no significant differences in echogenic plaques,hyperechoic plaques,and mixed echogenic plaques between the CMBs and non-CMBs groups(P>0.05).The detection rate of the four plaque echo types of different degrees and different distributions of CMBs were not statistically significant(P>0.05).There are two models for Logistic regression analysis.In Model 1,the result of the relevant risk factors of CMBs showed that age,baseline systolic blood pressure,HCY,hs-CRP,and history of antithrombotic use were the risk factors of CMBs(P<0.05),for the carotid AS indices,CIMT(odds ratio[OR]:4.28;95%confidence interval[CI]:1.45-12.66;P=0.009)and Crouse score(OR:1.10;95%CI:1.01-1.20;P = 0.038)had a significant impact on the occurrence of CMBs.The CIMT group was further divided into the CIMT normal,thickening,and plaque groups.Comparison between groups showed that the CIMT-thickening group(OR:2.64;95%CI:1.11-6.25;P = 0.03)and the plaque group(OR:3.31;95%CI:1.36-8.05;P = 0.01)were more susceptible to CMBs.In Model 2,we designated the no plaque study object as the reference group,and compared low echo plaque,equal echo plaque,high echo plaque and mixed echo plaque with respect to the reference group.The results showed that the risk of CMBs in the low echo plaque group was 6.93 times that of no plaque group,and was statistically significant(OR:6.93;95%CI:1.47,-32.69;P=0.014).The risk of CMBs echogenic plaques,hyperechoic plaque and mixed echo plaques was 2.36,1.93,and 1.09 times that of no plaque group respectively,but no statistically significant(P values were 0.168,0.197,0.902,respectively).The receiver operating characteristic curve analysis of the carotid atherosclerosis indices showed a statistically significant difference.The carotid intima-media thickness value combined with Crouse score was the best indicator(P<0.01).Conclusion:Age,baseline systolic blood pressure,HCY,hs-CRP,medication history of antithrombotic drugs,and carotid atherosclerosis are risk factors for CMBs.In patients with ischemic stroke,cerebral microbleeds are closely related to carotid atherosclerosis.Patients with hypoechoic plaque are more likely to develop CMBs.The occurrence of CMBs is not associated with carotid atherosclerosis on the ipsilateral side.Active control of carotid atherosclerosis is important to prevent cerebral microbleeds in patients with ischemic stroke.Background:Currently,ischemic stroke is a serious global problem with high recurrence rate that imposes severe human-health burden,while ischemic stroke combined with cerebral microbleeds(CMBs)or white matter lesions(WML)is more serious.WML occurs mostly in the elderly population.The pathogenesis of CMBs and WML is related to destruction of the blood-brain barrier,with many risk factors for disease onset,such as the patients' age,hypertension,and hyperlipidemia.CMBs and WML belong to cerebral small vessel disease.CMBs is hemorrhagic change of cerebral small vessel disease,which is manifested by the deposition of hemosiderin;whereas,WML is ischemic change of cerebral small vessel disease,which shows the loss of brain cells and myelin.Clinically,we found that brain microbleeds are often associated with WML.WML is common in the elderly population,and CMBs are present in different populations.The concept that small vascular disease causes big trouble was proposed on the International Stroke Conference and the European Stroke Conference of 2008.Definitude of the correlation between CMBs and WML can provide more basis for the diagnosis,prevention and treatment of clinical cerebral small vessel disease.Purpose:Cerebral microbleeds(CMBs)and white matter lesions(WML)belong to the type of cerebral small vessel disease.The correlation between cerebral microbleeds and white matter lesions in patients with ischemic stroke remains unclear.This study aims to explore the correlation between the two.Methods:Choose from September 2016 to November 2017 to see a patient with ischemic stroke in a neurology department or hospital in Taian Central Hospital.All patients underwent brain magnetic resonance imaging and T1-weighted imaging,T2-weighted imaging,fluid-attenuated inversion recovery,and susceptibility-weighted imaging was performed.The acquired images were read by two experienced physicians in the imaging department,and related image data were recorded.According to the results of brain MRI,the patients were divided into the WML group(153 cases)and non-WML group(45 cases).The white matter lesions were graded according to the Fazekas score,and the clinical baseline data of different degrees of white matter lesions were compared.WML scoring was per Fazekas rating scale(0-6points).The periventricular hyperintensities(PVH)and the deep white matter hyperintensities(DWMH)were scored separately,and subsequently added as the total score.Overall,the grading was as follows.Cerebral ventricular high-signal score:0 points,no high-signal lesions;1 point,cap-like or pencil-thin-like lesions;2 points,lesions showing smooth halos;and 3 points,high-signal irregularities around the ventricles.DWMH;0 points,no high-signal lesions;1 point,spotted lesions;2 points,lesions beginning to fuse;and 3 points,lesions showing large-area fusion.With regard to the total score,the score was divided into grade 0(0)?grade 1(1),grade 2(2-3),and grade 3(4-6);and per severity of CMBs,it was divided into 0-3 grades:Grade 0,absence of CMBs lesion;grade 1,one to five lesions;grade 2,six to 10 lesions;and grade 3,>101esions.We used MMSE as a cognitive function evaluation method.Correlation between cerebral microbleeds and white matter lesions in patients with ischemic stroke was studied and logistic regression analysis of patients with cerebral microbleeds complicated with white matter lesions was made.Results:In this study,there were 153 cases of WML and 45 cases of no WML in patients with ischemic stroke.Patients with WML were divided into four groups according to the degree of WML.The patients'age,history of hypertension,hs-CRP,HCY and indicators of carotid atherosclerosis(Carotid intima-media thickness(CIMT),Crouse score)were significantly different in patients with different degrees of WML(P<0.05).The results showed that an increase in grade of CMBs resulted in a corresponding increase in the detection rate of WML,PVH and DWMH(P<0.01).The detection rates of WML,PVH and DWMH were higher in the deep brain/infratentorial group than in the lobar group(P<0.05).The scores of WML,PVH and DWMH were also higher in the deep brain/infratentorial group than in the lobar group(P<0.01).The bar graph of WML,PVH and DWMH scores of patients with different grades of CMBs showed that with the aggravation of CMBs,the WML,PVH and DWMH scores also increased,with statistically significant differences(P<0.001).A graph of different levels of WML and number of CMBs shows that as the degree of WML increases,the number of CMBs also increases(P<0.001).In this study,CMBs grade and WML grade,CMBs' number and total WML score,CMBs grade and total WML score,WML grade and CMBs'number with r-value of 0.600,0.540,0.646 and 0.685,respectively,and each P<0.001 indicating statistically significant differences.This study screened patients with CMBs(excluded WML),WML patients(excluded CMBs),and CMBs with WML.CIMT and Crouse scores were used as indicators of carotid atherosclerosis.The results showed that CIMT and Crouse scores were highest in CMBs combined with WML group,followed by CMBs(excluded WML)and WML(excluded CMBs).The difference in the groups was statistically significant(P<0.001).This study screened patients with CMBs(excluded WML),CMBs and WML.The number of CMBs in patients with CMBs combined with WML was higher than that in patients with CMBs(excluded WML),and the difference was statistically significant(P<0.05).This study screened patients with WML(excluded CMBs),CMBs combined with WML.The PVH score was higher in the CMBs combined with the WML group than in the WML group(excluded CMBs),and the difference was statistically significant(P<0.001).The DWMH score was higher in the CMBs combined with the WML group than in the WML group(excluded CMBs),and the difference was not statistically significant(P>0.05).WML scores were higher in the CMBs combined with the WML group than in the WML group(excluded CMBs),and the difference was statistically significant(P<0.001).In this study,patients with CMBs(excluded WML),WML patients(excluded CMBs),and CMBs combined with the WML were screened.Compare the cognitive impairment in the three groups.MMSE was chosen as an indicator for evaluating cognitive function.The results showed that the MMSE scores decreased in the CMBs group(excluded WML)(26.43±3.21),the WML group(excluded CMBs)(25.43±2.39),and the CMBs combined with the WML group(25.80±2.49),but the difference was not statistically significant(P>0.05).The patients with CMBs combined with WML was used as state variables.The CIMT,Crouse scores,and the combined effects of CIMT and Crouse scores were used as test variables.The results show that the area under the ROC curve is 0.681,0.710,and 0.762,respectively(P<0.01).The better index is the comprehensive evaluation effect of CIMT combined with Crouse integral(AZ=0.762,P<0.001).Among patients with ischemic stroke,the patients with CMBs combined with WML as dependent variable,gender,age,history of diabetes,hypertension,coronary heart disease,hyperlipidemia,hemorrhage,and antithrombotic use,systolic blood pressure,diastolic blood pressure,high-sensitivity C reactive protein(hs-CRP),homocysteine(HCY),and carotid atherosclerosis as independent variables.Logistic regression analysis revealed significant factors including the age,history of hypertension and antithrombotic therapy,systolic blood pressure,high-sensitivity CRP,and absence of risk factors of carotid atherosclerosis(P<0.05)in patients experiencing ischemic stroke with CMBs in the WML.Conclusion:In patients with ischemic stroke,age,history of hypertension,history of antithrombotic medication,baseline systolic blood pressure at admission,hs-CRP,and presence or absence of carotid atherosclerosis are risk factors for CMBs combined with WML.The higher the degree of CMBs,the higher the proportion and score of PVH,DWMH,and WML detected.The detection rate and number of CMBs increases as the degree of WML increases.Patients with CMBs combined with WML had more severe carotid atherosclerosis,WML,and CMBs.Cognitive impairment in patients with CMBs combined with WML,patients with WML(excluded CMBs),and patients with CMBs(excluded WML)was impaired,but the difference in the three groups was not significant.CIMT*Crouse score predicts the occurrence of CMBs combined with WML.CMBs are positively correlated with the severity of WML,and they may be risk factors for each other.It is speculated that the two may be different pathological results under the same factors.