Analysis Of The Relationship Between Cerebral Small Vessel Disease And Large Artery Atherosclerosis

Background and PurposeCerebral small vessel disease(CSVD)is a series of clinical syndromes resulting from pathological changes of various etiologies affecting small perforating arteries,arterioles,capillaries and venules.Neuroimaging features of CSVD include lacunar infarction,white matter hyperintensities,cerebral microbleeds,brain atrophy and enlarged perivascular spaces.At present,there are few managements targeting cerebral small vessel disease.The main reason is that small cerebral vessels are difficult to be observed directly,and the pathogenic mechanism is not clear.The cerebral vascular tree is composed of cerebral large vessels and cerebral small vessels,which are structurally and functionally connected.In addition,large blood vessels and small blood vessels in the brain have the same risk factors,such as age and hypertension.Therefore,cerebral small vessel disease often coexists with intracranial large artery disease in theoretically.The purpose of this study was to explore the risk factors of cerebral small vessel disease and relationship between cerebral small vessel disease and large artery atherosclerosis.MethodsIn this study,ischemic stroke patients hospitalized in the Department of Neurology,the Second Affiliated Hospital of Harbin Medical University from May2018 to December 2019 were included in this study.All the patients included in the study had certain degree of atherosclerotic lesions.Carotid artery stenosis,carotid plaque and carotid intima-media thickness were selected as the observation indexes of large artery atherosclerosis.According to the imaging examination,the subjects were divided into CSVD group and non-CSVD group.Baseline information and risk factors including age,gender,height,weight,smoking history,hypertension,diabetes and coronary heart disease,LDL-C and triglycerides were collected.All patients underwent carotid ultrasound examination and MRI examination to determine the index of large artery atherosclerosis.MRI and susceptibility weighted imaging were used to determine the neuroimaging of cerebral small vessel disease.Finally,the general linear regression model and logistic regression analysis were used to explore the risk factors of cerebral small vessel disease and the correlation between cerebral small vessel disease and large artery atherosclerosis.ResultsA total of 241 patients with ischemic stroke were included in this study,including 115 patients with CSVD and 126 patients with non-CSVD.In the small vessel disease group,56 cases(48.70%)had lacunar infarction,68 cases(59.13%)had different degrees of white matter lesions.There were 55 cases(47.83%)with perivascular space enlargement,42 cases(36.52%)with microbleeds and 47 cases(40.87%)with brain atrophy.By multivariate regression analysis,age,smoking,hypertension,diabetes,high LDL-C were independent risk factors of cerebral small vessel disease(P < 0.05).Age,coronary heart disease and high LDL-C were independent risk factors of lacunar infarction(P<0.05).Age and high LDL-C were independent risk factors of cerebral white matter lesion(P<0.05).Age and hypertension were independent risk factors of cerebral atrophy(P<0.05).Diabetes mellitus was the independent risk factor of microbleeds(P<0.05).Age and diabetes mellitus were the independent risk factors of perivascular space enlargement(P<0.05).After adjusting the risk factors of each subtype,lacunar infarction was associated with intracranial artery stenosis(P<0.05).White matter hyperintensities was correlated with carotid intima-media thickness(P<0.05).Cerebral atrophy was associated with intracranial artery stenosis and carotid intima-media thickness(P<0.05).Enlarged perivascular spaces were correlated with carotid intima-media thickness(P<0.05).There was no significant statistical result between the cerebral microbleeds and carotid intima-media thickness because of the collinearity.There was no significant correlation between the cerebral microbleeds and intracranial artery stenosis or carotid artery plaque(P>0.05).ConclusionsAge,smoking,hypertension,diabetes mellitus and increased LDL-C were independent risk factors for CSVD.The risk factors of different subtypes of CSVD are not identical.It can provide some guidance for the secondary prevention of CSVD.CSVD is associated with LAA,and different subtypes have different correlations with LAA.LAA can indicate the prevalence of CSVD to a certain extent,and provide help for clinical diagnosis and treatment of CSVD.