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Association of intracranial atherosclerotic stenosis with severity of white matter hyperintensities
Author(s) -
Park J.H.,
Kwon H.M.,
Lee J.,
Kim D.S.,
Ovbiagele B.
Publication year - 2015
Publication title -
european journal of neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.881
H-Index - 124
eISSN - 1468-1331
pISSN - 1351-5101
DOI - 10.1111/ene.12431
Subject(s) - medicine , hyperintensity , stenosis , cardiology , stroke (engine) , incidence (geometry) , lesion , magnetic resonance imaging , magnetic resonance angiography , white matter , radiology , surgery , mechanical engineering , physics , optics , engineering
Background and purpose White matter hyperintensities ( WMH s) on magnetic resonance imaging ( MRI ) have been linked to small‐vessel disease, but the precise pathogenesis underlying WMH s remains unclear. Studies about an association of WMH s with extracranial atherosclerotic stenosis ( ECAS ) showed conflicting results and the relationship of WMH s with intracranial atherosclerotic stenosis ( ICAS ) is uncertain. Methods A cross‐sectional study of 679 consecutive Korean patients with acute ischaemic stroke (mean age 67.8 ± 12.6; 395 males) who underwent brain MRI /MR angiography was conducted. Severity of deep WMH s (d‐ WMH s, n = 560) and periventricular WMH s (p‐ WMH s, n = 590) was rated separately and compared across three groups: ICAS ( n = 318), ECAS ( n = 71) and no cerebral atherosclerotic stenosis ( NCAS ) ( n = 290). Results The ICAS group showed a higher d‐ WMH /p‐ WMH score (1.62 ± 0.85/1.65 ± 0.79) than both the ECAS (1.25 ± 0.87/1.23 ± 0.78) and NCAS (1.19 ± 0.92/1.24 ± 0.81) groups ( P < 0.001 for all). Patients with a greater number of ICAS were more likely to have higher scores of d‐ WMH /p‐ WMH ( P < 0.001 for all). Patients with higher scores of d‐ WMH /p‐ WMH had a higher incidence of ICAS ( P < 0.001 for all), but not of ECAS or NCAS . In multivariable analysis, a dose−response relationship was observed between the extent of ICAS versus WMH s. Compared with one ICAS lesion, for d‐ WMH s the odds ratio ( OR ) = 2.61 [95% confidence interval ( CI ) 0.95–7.20] for two ICAS lesions and OR = 3.37 (1.10–10.32) for ≥3 ICAS lesions; whilst for p‐ WMH s (score ≥2) OR = 1.70 (95% CI 0.96–2.98) for two ICAS lesions and OR = 2.02 (1.15–3.55) for ≥3 ICAS lesions. Conclusion ICAS is independently associated with progressively greater WMH burden. The association of ICAS with WMH severity appears to be stronger than that of ECAS / NCAS in the Korean (Asian) stroke population.