Association Of Enlarged Perivascular Space In Basal Ganglia With Atherosclerotic Stenosis And Occlusion Of Middle Cerebral Artery

Background:MRI-visible enlarged perivascular space in the basal ganglia(BG-EPVS)is a key marker of small cerebral vascular diseases(cSVD).Previous studies showed BG-EPVS is associated with stroke,cognitive impairment,parkinson’s disease or extrapyramidal syndrome.However,little is known about pathogenesis and clinical significance of BG-EPVS.Age and hypertension are independent risk factors of BG-EPVS,whereas the association of BG-EPVS with smoking,dyslipidemia,ischemic cardiomyopathy,diabetes is still controversial.The association between BG-EPVS and atherosclerosis has been investigated,whereas intracranial atherosclerosis was excluded in these studies.To the best of our knowledge,the association of BG-EPVS with intracranial atherosclerosis remains uncertain.In the present study,we aimed to explore the association between atherosclerotic stenosis or occlusion of the middle cerebral artery and burden of BG-EPVS.The correlation between BG-EPVS and vascular risk factors and other markers of cerebrovascular disease were also investigated.Methods:We divided patients with MCA stenosis/occlusion into >10 BG-EPVS group and ≤10 BG-EPVS group by a well validated rating scale.We compared clinical and radiological features at baseline in patients with high and low burden of BG-EPVS.To evaluate the association of severity of MCA atherosclerosis with BG-EPVS burden,we calculated the odds ratio of MCA atherosclerotic stenosis/occlusion and BG-EPVS in a logistic regression model adjusting for age,presence of male,hypertension,diabetes,dyslipidemia and other MR-visible markers of cerebral small vessel disease.We compared the difference of BG-EPVS burden using Wilcoxon rank sum in patients with only unilateral MCA atherosclerotic stenosis or occlusion.Results:1.We retrospectively included 105 consecutive patients with MCA atherosclerotic stenosis(≥50%)or occlusion defined by CTA in Fujian Medical University Union Hospital from June 2014 to November 2018.2.The proportion of Lacunes,CMBs,moderate to severe WMH and median age of >10 BG-EPVS was significantly higher than that of ≤10 BG-EPVS(P< 0.001,P= 0.025,P= 0.037,P < 0.001).We found no significant difference in presence of male,smoking history,hypertension,diabetes,ischemic cardiomyopathy and hyperlipidemia between the two groups(P > 0.05,respectively).3.We found no significant difference in the number between ipsilateral and contralateral BG-EPVS(P=0.337 、 P=0.076)in patients with MCA 50-69% stenosis/occlusion using Wilcoxon rank sum test analysis.The number of BG-EPVS was significantly higher in ipsilateral side than that in contralateral side in patients with MCA 70-99% stenosis(12[9-14] Vs 9[7-12],P<0.002).4.In the univariate logistic regression analysis,age(P<0.001),LI(P=0.001),moderate to severe WMH(P=0.043)and CMBs(P=0.030)were significantly associated with presence of >10 BG-EPVS.In the multivariate binary Logistic regression,age(1.093,1.036-1.154,P=0.001),male(3.623,1.191-11.021,P=0.023),severe stenosis and occlusion of middle cerebral artery(7.103,1.622-31.105,P=0.009;5.143,1.373-19.261,P=0.015)and lacunar Infraction(3.469,1.102-10.918,P=0.033)were significantly associated with presence >10 BG-EPVS.Conclusion:Age,male and lacunar infarction were independently associated with >10 BG-EPVS.MCA severe stenosis and occlusion were independently associated with >10 BG-EPVS,Our study support the hypothesis that BG-EPVS can be used as a potential marker of MCA atherosclerotic stenosis.