Hemodynamic significance of intracranial atherosclerotic disease and ipsilateral imaging markers of cerebral small vessel disease

Lina Zheng; Xuan Tian; Jill Abrigo; Hui Fang; Bonaventure Ym Ip; Yuying Liu; Shuang Li; Yu Liu; Linfang Lan; Haipeng Liu; Hing Lung Ip; Florence Sy Fan; Sze Ho Ma; Karen Ma; Alexander Y Lau; Yannie Oy Soo; Howan Leung; Vincent Ct Mok; Lawrence Ks Wong; Yuming Xu; Liping Liu; Xinyi Leng; Thomas W Leung

doi:10.1177/23969873231205669

Hemodynamic significance of intracranial atherosclerotic disease and ipsilateral imaging markers of cerebral small vessel disease

Eur Stroke J. 2024 Mar;9(1):144-153. doi: 10.1177/23969873231205669. Epub 2023 Oct 6.

Authors

Lina Zheng^{1

2}, Xuan Tian¹, Jill Abrigo³, Hui Fang⁴, Bonaventure Ym Ip¹, Yuying Liu¹, Shuang Li¹, Yu Liu¹, Linfang Lan^{1

5}, Haipeng Liu^{1

6}, Hing Lung Ip¹, Florence Sy Fan¹, Sze Ho Ma¹, Karen Ma¹, Alexander Y Lau¹, Yannie Oy Soo¹, Howan Leung¹, Vincent Ct Mok¹, Lawrence Ks Wong¹, Yuming Xu⁴, Liping Liu², Xinyi Leng¹, Thomas W Leung¹

Affiliations

¹ Department of Medicine and Therapeutics, Chinese University of Hong Kong, Hong Kong SAR, China.
² Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
³ Department of Imaging and Interventional Radiology, Chinese University of Hong Kong, Hong Kong SAR, China.
⁴ Department of Neurology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
⁵ Department of Neurology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
⁶ Research Centre for Intelligent Healthcare, Faculty of Health and Life Sciences, Coventry University, Coventry, UK.

Abstract

Introduction: Cerebral small vessel disease (CSVD) commonly exists in patients with symptomatic intracranial atherosclerotic disease (sICAD). We aimed to investigate the associations of hemodynamic features of sICAD lesions with imaging markers and overall burden of CSVD.

Patients and methods: Patients with anterior-circulation sICAD (50%-99% stenosis) were analyzed in this cross-sectional study. Hemodynamic features of a sICAD lesion were quantified by translesional pressure ratio (PR = Pressure_{post-stenotic}/Pressure_pre-stenotic) and wall shear stress ratio (WSSR = WSS_{stenotic-throat}/WSS_pre-stenotic) via CT angiography-based computational fluid dynamics modeling. PR ⩽median was defined as low ("abnormal") PR, and WSSR ⩾ fourth quartile as high ("abnormal") WSSR. For primary analyses, white matter hyperintensities (WMHs), lacunes, and cortical microinfarcts (CMIs) were assessed in MRI and summed up as overall CSVD burden, respectively in ipsilateral and contralateral hemispheres to sICAD. Enlarged perivascular spaces (EPVSs) and cerebral microbleeds (CMBs) were assessed for secondary analyses.

Results: Among 112 sICAD patients, there were more severe WMHs, more lacunes and CMIs, and more severe overall CSVD burden ipsilaterally than contralaterally (all p < 0.05). Abnormal PR and WSSR (vs normal PR and WSSR) was significantly associated with moderate-to-severe WMHs (adjusted odds ratio = 10.12, p = 0.018), CMI presence (5.25, p = 0.003), and moderate-to-severe CSVD burden (12.55; p = 0.033), ipsilaterally, respectively independent of contralateral WMHs, CMI(s), and CSVD burden. EPVSs and CMBs were comparable between the two hemispheres, with no association found with the hemodynamic metrics.

Discussion and conclusion: There are more severe WMHs and CMI(s) in the hemisphere ipsilateral than contralateral to sICAD. The hemodynamic significance of sICAD lesions was independently associated with severities of WMHs and CMI(s) ipsilaterally.

Keywords: Cerebral small vessel disease; cortical microinfarct; hemodynamics; intracranial atherosclerotic disease; white matter hyperintensity.

MeSH terms

Cerebral Small Vessel Diseases* / diagnostic imaging
Cross-Sectional Studies
Hemodynamics
Humans
Intracranial Arteriosclerosis* / diagnostic imaging
Magnetic Resonance Imaging / methods