A Study On Correlation Between Intracranial And Extracranial Atherosclerotic Stenosis And White Matter Hyperintensition

Purpose:Try to verify the vascular risk factors related to white matter hyperintensities(WMHs)and to explore the relationship between intracranial and extracranial atherosclerotic stenosis and the generation and severity of WMHs.Methods:We retrospectively analyzed the clinical data of the patients who were hospitalized in the neurology department of Tianjin Huanhu hospital from March 2016 to December 2019 with the first diagnosis of ischemic cerebrovascular disease.The data included general data,basic diseases,medication,smoking,drinking,fasting blood glucose,total cholesterol,triglyceride,liver function,kidney function,homocysteine,hypersensitive C-reactive protein,head MRI,head and neck MRA or aortic arch-intracranial CTA.The patients were divided into periventricular white matter hyperintensities(PVWMHs)group and deep white matter hyperintensities(DWMHs)group.Simultaneously,they were divided furtherly into no WMHs subgroup,mild WMHs subgroup,moderate WMHs subgroup and severe WMHs subgroup by the modified Fazekas scale.We also divided intracranial and extracranial major vessels into four grades: no or mild stenosis,moderate stenosis,severe stenosis and vascular occlusion based on the calculation of warfarin-aspirin symptomatic intracranial disease and the standard of North American symptomatic carotid endarterectomy tria.SPSS 22.0 was used to analyze all above data.The normally distributed data were reported as mean ± standard deviation.T-test was used for data comparison between the two groups and ANOVA was for comparison among multiple groups.The enumeration data were expressed by rate,and the data between groups were compared by chi-square test.The risk factors of WMHs and the relationship between vascular stenosis and WMHs were both analyzed by binary logistic regression analysis.The correlation between the severity of WMHs and the vascular stenosis was studied by multinomial logistic regression analysis.Results:A total of 357 patients were involved in this study with a mean age of 61.58 ± 10.96 years.Among them,36.6%(129)were women.273 patients had DWMHs and 262 patients had PVWMHs.DWMHs group had a statistical significance(P < 0.05)in age,high systolic blood pressure and history of hypertension,stroke,antihypertensive drugs,antiplatelet drugs and the atherosclerotic stenosis of left internal carotid artery(LICA),right internal carotid artery(RICA),left middle cerebral artery(LMCA),left posterior cerebral artery(LPCA),right posterior cerebral artery(RPCA)and left vertebral artery(LVA).PVWMHs group had a statistical significance(P < 0.05)in age,high fasting blood glucose,high systolic blood pressure and history of hypertension,stroke,antihypertensive drugs,hypoglycemic drugs,antiplatelet drugs and the atherosclerotic stenosis of left anterior cerebral artery,LICA,RICA,LMCA,LPCA,RPCA,LVA and right vertebral artery.Logistic regression analysis presented that age,high systolic blood pressure,high fasting blood glucose,history of hypertension,stroke,history of antihypertensive drugs,lipid-lowering drugs,hypoglycemic drugs and antiplatelet drugs were risk factors for WMHs.In particular,age and history of stroke were independent risk factors for WMHs.Single stenosis of any vessel was not an independent risk factor for WMHs.Intracranial atherosclerotic stenosis(ICAS),extracranial atherosclerotic stenosis,the coexistence of intracranial and extracranial atherosclerotic stenosis(Co-CAS)were independent risk factors for DWMHs.ICAS and Co-CAS are independent risk factors for PVWMHs,and also,they were associated with moderate to severe WMHs.Conclusion:Correlation analysis manifested that age and stroke history were independent risk factors for WMHs.Simultaneously,there were many common risk factors between WMHs and intracranial and extracranial atherosclerotic stenosis.Multiple intravascular and extracranial stenosis might increase the risk of WMHs.ICAS and Co-CAS were closely related to moderate to severe WMHs.In clinical work,it is important to pay full attention to the relationship between WMHs and intracranial and extracranial arterial disease.Further research should be carried out in future.