COVID-19 vaccination and cerebral small vessel disease progression—A prospective cohort study

Abstract

Objectives

The association between SARS-CoV-2 spike protein and cerebrovascular diseases raised a concern of cerebrovascular safety of COVID-19 vaccines. We aimed to determine the risk of radiologic cerebral small vessel disease (cSVD) progression with BNT162b2 and CoronaVac.

Methods

In this community-based prospective cohort study, community-dwelling subjects underwent brain magnetic resonance imaging (MRI) before and 4 months after vaccination with BNT162b2 or CoronaVac. Unvaccinated subjects received serial brain MRI over a comparable interval. The primary outcome was progression of a composite of six standard cSVD biomarkers. We compared the risk of cSVD progression between vaccinated and unvaccinated subjects and identified predictors of primary outcome within each vaccine subgroup.

Results

Of the 415 subjects recruited, 190 received BNT162b2, 152 received CoronaVac, and 73 remained unvaccinated. A total of 60 (14.4%) had COVID-19 infection before follow-up MRI, and 109 (26.3%) developed the primary outcome. Neither BNT162b2 (adjusted odds ratio [aOR] 0.61, 95% confidence interval [CI] 0.30-1.26, P = 0.179) nor CoronaVac (aOR 0.71, 95% CI 0.34-1.47, P = 0.349) was associated with cSVD progression. Among the BNT162b2 recipients, a higher surrogate virus neutralization test was associated (aOR 0.97, 95% CI 0.95-0.99, P = 0.002) with a lower risk of cSVD progression.

Conclusions

BNT162b2 and CoronaVac did not increase cSVD burden in community-dwelling citizens. The association between surrogate virus neutralization test and cSVD progression among BNT162b2 recipients requires further investigation.