颈动脉狭窄对皮质微梗死、白质完整性和脑容量的影响：基于人群的鹿特丹研究的半球间比较

IF 2.8 Q3 CLINICAL NEUROLOGY

Cerebral circulation - cognition and behavior Pub Date : 2025-01-01 DOI:10.1016/j.cccb.2025.100391

Frank J. Wolters , Meike W. Vernooij , Gennady V. Roshchupkin , M․Arfan Ikram , Maryam Kavousi , Peter J. Koudstaal , Aad van der Lugt , Daniel Bos

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引用次数: 0

摘要

背景：颈动脉狭窄可通过慢性缺氧和缺血导致脑功能逐渐丧失。方法：我们纳入了基于人群的鹿特丹研究（Rotterdam Study）的连续参与者，他们在颈动脉分叉处单侧狭窄≥50%，并在飞行时间颈动脉MR血管造影上比较两脑半球缺血性病变的存在、组织体积和脑结构MRI上的白质完整性。结果在50名参与者中（平均年龄76岁，50%为女性），受影响一侧颈动脉的血流低于未受影响一侧(160mL/min vs 202mL/min；狭窄每增加1%，血流减少[95% CI]: 1.7 mL/min[1.0-2.5])。12人有皮质梗死的影像学证据，其中8人有皮质微梗死，均在狭窄一侧（P = 0.001）。在狭窄动脉下游，脑实质体积低于对侧半球（平均差值：-2.7 mL[-4.9;-0.4]），灰质和白质相似。差异在额顶叶中最为显著，并且随着狭窄程度的增加而增加，在狭窄≥70%的个体中约为5 mL。脑半球间白质高强度体积和微结构完整性没有差异。结论颈动脉狭窄与下游皮层微梗死及低实质组织体积有关。

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Effect of carotid artery stenosis on cortical microinfarcts, white matter integrity, and brain volume: An interhemispheric comparison within the population-based Rotterdam Study

Background

Carotid artery stenosis could contribute to gradual loss of brain function through chronic hypoxia and ischemia.

Methods

We included consecutive participants of the population-based Rotterdam Study with unilateral ≥50 % stenosis at the carotid artery bifurcation on time-of-flight carotid MR angiography, and compared between hemispheres the presence of ischemic lesions, tissue volumes, and white matter integrity on structural brain MRI.

Results

Among 50 participants (mean age 76 years, 50 % women), flow was lower in the affected carotid artery than on the unaffected side (160mL/min versus 202mL/min; flow reduction [95 %CI] per 1 % increase in stenosis: 1.7 mL/min [1.0–2.5]). Twelve individuals had radiographic evidence of cortical infarction, of whom 8 had cortical microinfarcts, all on the side of the stenosis (P = 0.001). Downstream of the stenotic artery, parenchymal volume was lower than in the contralateral hemisphere (mean difference: -2.7 mL [-4.9;-0.4]), similar for grey and white matter. Differences were most profound in the frontoparietal lobes, and increased with severity of stenosis to roughly 5 mL in individuals with ≥70 % stenosis. White matter hyperintensity volume and microstructural integrity did not differ between hemispheres.