The Association Between Atherosclerosis And Leukoraiosis

Part one The Association between Leukoaraiosis and Carotid Atherosclerosis: A Systematic Review and Meta-analysisObjectives:The relationship between carotid atherosclerosis and LA remains controversial. We performed a systematic review on the association of carotid atherosclerosis and LA to further elucidate the pathogenesis of LA.Methods:Pub Med, Embase, and Web of Science were searched for articles published up to Feb. 2014. Thirty-two studies that examined the relationship between LA and carotid atherosclerosis were included. The pooled estimate, subgroup analyses, sensitivity analysis and publication bias were performed using Review Manager 5.2.4.Results:(1) Thirty-two studies including 17,721 patients were identified. There were 7(30%) out of 23 studies reporting significant association between LA and carotid stenosis; 11(79%) out of 14 studies reporting significant association between LA and carotid plaque; all 9 studies reporting significant association between LA and carotid intima-media thickness(IMT); one study showing an association between LA and CAWT(similar to the role of the IMT).(2) Ten studies were included in quantitative synthesis. The combined OR was 1.10(95% CI: 0.61-1.98), which showed that carotid atherosclerosis was not associated with LA. In the subgroup analyses, significant associations were found between LA and carotid plaque(OR=3.53; 95% CI = 1.83–6.79), and the result of IMT group showed that increased IMT increased risk of LA(MD= 0.11; 95% CI =0.01–0.22). Interestingly, the result of stenosis group showed that carotid stenosis was a protective factor for LA(OR=0.53; 95% CI =0.32–0.87).Conclusions:This systematic review suggested that LA has a tendency of association with carotid plaques which have the potential to cause artery-to-artery thromboembolization, but no association with simple carotid stenosis.Part Two Severity of Leukoaraiosis Correlates with Intracranial Atherosclerosis.Objectives:Few studies focused on the relationship between intracranial atherosclerosis and LA. We will further explore the relationship between the severity of leukoaraiosis and intracranial atherosclerosis.Methods:A cohort of 213 patients who were diagnosed as LA by MRI between February 2013 and December 2014 at the Department of Neurology of our hospital was enrolled. The patients were underwent head CTA or DSA during the same period. All patients were divided into mild LA group(n=118)and moderate-severe LA group(n=95). Relationship of severity of LA and intracranial atherosclerosis was analyzed.Results:(1) Among the 95 moderate-severe LA patients, 73(76.8%) patients had “significant stenosis”.Extracranial stenosis(ECS), intracranial stenosis(ICS), mixed stenosis(MS) and lipide plague(LP) was 14(14.7%), 36(37.9%), 23(24.2%) and 26(27.4%),respectively; Among the 118 mild LA patients, 44(37.3%) patients had “significant stenosis”.ECS, ICS, MS and LP was 12(10.2%),22(18.6%),10(8.5%)and 10(8.5%), respectively. The ICS and MS were more presented in moderate-severe LA patients than mild LA(χ2 =9.843,p=0.002;χ2 =9.954,p=0.002). There was no significant difference in the distrubition of ECS between the two groups(χ2 =1.024, p = 0.311), and LP was more presented in moderate-severe LA patients than mild LA(χ2 =13.377,p=0.000).In the periventricular LA, the MS and LP were more presented in moderate-severe LA patients than mild LA(χ2 =8.447,p=0.004;χ2 =12.294,p=0.000), but there was no significant difference in the distrubition of ECS and ICS between the two groups(χ2 =0.83,p=0.362;χ2 =3.552,p=0.059). In the subcortical LA, the ICS and LP were more presented in moderate-severe LA patients than mild LA(χ2 = 11.605,p=0.001;χ2 = 4.547,p=0.033), but there was no significant difference in ECS and MS between the two groups(χ2 = 0.549,p=0.459;χ2 = 0.614,p=0.433).(2) Logistic regression analysis showed that ICS,MS and LP was increases the risk of moderate-severe LA(OR=2.663, 95% CI = 1.430-4.958,p=0.002; OR=3.450, 95% CI = 1.550-7.679,p=0.002; OR=4.070,95% CI = 1.848-8.961, p<0.001); After adjusted by other risk factors, MS and LP were positive related to moderate-severe LA patient than mild LA(adjusted OR=4.004, 95% CI = 1.615-9.926,p=0.003; adjusted OR=4.054, 95% CI = 1.504-10.922,p=0.006), but there was no association between ECS and ICS and the moderate-severe LA.After adjusted by other risk factors, MS and LP was increases the risk of moderate-severe LA in the periventricular LA(adjusted OR=3.205, 95% CI = 1.355-7.577,p=0.008; adjusted OR=3.244, 95% CI = 1.299-8.100,p=0.012); In the subcortical LA, the logistic analysis showed that ICS and LP was the risk factor for moderate-severe LA(OR=2.738, 95% CI = 1.415-5.297,p=0.003; OR=2.613, 95% CI = 1.230-5.551,p=0.012), but there was no association after adjusted risk factors.(3) After adjusted by other risk factors, the age and hypertension were increases the risk of moderate-severe LA(adjusted OR=5.314, 95% CI = 2.591-10.899,p<0.001; adjusted OR=3.996, 95% CI = 1.716-9.309,p=0.001).Conclusions:(1) MS and LP increases the risk of moderate-severe LA, especially in periventricular LA.(2) The age and hypertension was increases the risk of moderate-severe LA.