The Interaction Effect Between Cerebral Large-vessel Diseases And Small Vessel Disease In The NICE Population

Objective:The aim of this study was to analyze baseline data,imaging characteristics of cerebral small vessel disease(CSVD),cerebral large-vessel diseases,cognitive performance of patients in the non-disabling ischemic cerebrovascular events(NICE)population;to investigate risk factors of CSVD,the relationship between cerebral large-vessel diseases and CSVD,the effect of different patterns of CSVD imaging features and intracranial and extracranial artery stenosis on cognition.Methods:Patients with minor ischemic stroke and transient ischemic attack(TIA)who were hospitalized from March 2018 to August 2019 were included.Demographic data,indicators of large-vessel diseases,CSVD imaging markers and the score of Mini Mental State Examination were collected.The data were compared between groups with and without intracranial and/or extracranial artery stenosis,groups with and without multiple plaques.Univariate analysis was used to analyze the association of risk factors and cerebral large-vessel diseases with CSVD.Logistic regression models were used to explore the relationship between cerebral large-vessel diseases and CSVD,the effect of different patterns of CSVD imaging features and intracranial and/or extracranial artery stenosis on cognition.Results:204 patients with minor ischemic stroke and TIA were enrolled.The average age was 64.82 years old,38.2%were female.66.2%of the patients had cerebral artery plaques,48.5%of the patients had multiple plaques,40.7%of the patients had intracranial and/or extracranial artery stenosis.In the aspect of CSVD imaging markers,the proportion of patients with lacunes,severe periventricular white matter hyperintensities(PVWMH),severe deep white matter hyperintensities(DWMH),severe enlarged perivascular space(EPVS)in basal ganglia(BG),severe EPVS in centrum semiovale(CS)was 52.0%,43.1%,27.5%,42.6%,42.2%,respectively.33.8%of the patients had cognitive dysfunction.Compared with the group without multiple plaques,the group with multiple plaques were older,had lower creatinine clearance rate and had more patients with severe PVWMH and severe DWMH(P<0.05).Univariate analysis showed that age,female,systolic blood pressure,homocysteine,hypertension,diabetes,right carotid intima-media thickness(IMT),plaques,unstable plaques,and multiple plaques were associated with lacunes;age,body mass index,creatinine clearance rate,triglyceride,high density lipoprotein cholesterol,plaques,and multiple plaques were associated with PVWMH;age,creatinine clearance rate,triglyceride,high density lipoprotein cholesterol,hypertension,plaques,and multiple plaques were associated with DWMH;age,female,body mass index,creatinine clearance rate,low density lipoprotein cholesterol were associated with BG-EPVS;age was associated with CS-EPVS(P<0.05).Logistic regression analysis indicated that the right carotid IMT(OR=62.03,95%CI:3.32-1158.18;P=0.0057),the left carotid IMT(OR=19.42,95%Cl:1.28-294.83;P=0.0326)were associated with the presence of lacunes.Comparing absence of intracranial and/or extracranial artery stenosis combined mild CS-EPVS,the risk of cognitive impairment increased significantly in patients presence of intracranial and/or extracranial artery stenosis combined severe CS-EPVS(OR=3.03,95%CI:1.04-8.79;P=0.0418).Conclusion:In the NICE population of this study,large-vessel diseases such as plaques and intracranial and/or extracranial artery stenosis coexist with CSVD imaging damages such as lacunes,white matter hyperintensities and EPVS,and various risk factors coexist.There were some differences in risk factors among NICE patients with different CSVD imaging lesions.Patients with intracranial and extracranial artery stenosis combined CSVD imaging lesions(severe CS-EPVS)are at higher risk for cognitive impairment.