Correlation Between Intracranial Atherosclerosis And White Matter Hyperintensities In Acute Ischemic Stroke

Objective:The purpose of this study was twofold.First,to investigate whether there were differences in the severity of white matter hyperintensities(WMHs)in acute ischemic stroke(AIS)of multiple causes.Second,to analyze the relationship between intracranial atherosclerosis(ICAS)and WMHs in patients with AIS.Methods:The data of 460 patients who were diagnosed as AIS and completed brain magnetic resonance imaging(MRI)was collected retrospectively,all the patients were hospitalized in the first Hospital of Lanzhou University from January2017 to October 2018.AIS was classified according to different causes based on the new Trial of Org 10172 in Acute Stroke Treatment(TOAST)classification and the Chinese cerebrovascular diseases classification(2015).The severity of periventricular white matter hyperintensities(p-WMHs)and deep white matter hyperintensities(d-WMHs)was assessed using the Fazekas grading criteria.Chi-square test was used to analyze the severity of p-WMHs and d-WMHs in AIS of various causes,and the differences were intuitively displayed by stacking percentage histogram.According to the manifestations of intracranial arterial lesions on the three-dimensional time of flight MR angiography(3D-TOF-MRA),they were divided into normal group,sclerosis group,stenosis group and occlusion group.The overall WMHs scores of each group were compared.Then the correlation between ICAS and WMHs was judged by spearman correlation analysis and Cochran-Armitage trend test.Finally,the Fazekas score of 2 to 3 was defined as severe WMHs lesions.Univariate Logistic regression and multivariate Logistic regression models were used to analyze the relationship between ICAS and severe p-WMHs,so did the relationship between ICAS and severe d-WMHs.Results:The results of chi-square test showed that the severity of p-WMHs and d-WMHs was not exactly the same in different causes of AIS(?~2=38.392,P<0.001;?~2=33.687,P=0.001),large artery atherosclerotic stroke(LAA)was more likely to have severe p-WMHs lesions.Kruskal-Wallis H test showed that the overall score of WMHs among the sclerosis group,stenosis group and occlusion group did not differ in AIS of various causes(the P Values were 0.079,0.277,0.074,respectively).Trend test showed there was a linear relationship between ICAS with p-WMHs(P=0.037),and an quadratic trend with d-WMHs(P=0.001).Multivariate Logistic regression analysis showed that age and hypertension were common risk factors for severe p-WMHs and d-WMHs(all P values<0.001).Intracranial arterial occlusion increased the risk of severe p-WMHs[OR=2.613,5%CI(1.209-5.548),P=0.015],and there was nosignificantassociationwithsevered-WMHs[OR=1.804,95%CI(0.898-3.624),P=0.097].Conclusions:The severity of WMHs in AIS of different causes was discrepant,LAA was more likely to be complicated with severe p-WMHs.There was a linear trend between ICAS and p-WMHs.Regardless of the effect of other factors,intracranial artery occlusion increased the risk of severe p-WMHs,and unrelated to the severe d-WMHs.