Correlation Of Cerebral Microbleed And Cerebral Artery Stenosis In Patients With Non-cardiogenic Ischemic Stroke

Objective:To investigate the correlation between cerebral microbleed(CMB)and cerebral artery stenosis in patients with non-cardiogenic ischemic stroke.METHODS:A total of 512 patients with non-cardiogenic ischemic stroke who were hospitalized in the Department of Neurology,Affiliated Hospital of Qingdao University from October 2018to January 2022 were retrospectively included.All available data including demographics(such as gender,age,etc.),risk factors for cerebrovascular disease(such as hypertension,diabetes,etc.),lifestyle(smoking and drinking),laboratory test results(such as fasting blood glucose,Triglycerides,etc.)and imaging data(CMB,cerebral artery stenosis,etc.)were collected.According to of the features of susceptibility weighted imaging(SWI),patients were grouped as non-CMB group and CMB group.We analyzed the detection rate of CMB and investigated the potential risk factors for CMB by univariate analysis and multivariate binary logistic regression in the acute phase of patients with non-cardiogenic ischemic stroke.Furtherly,we classified CMB by severity[grade 1(mild),grade 2(moderate),and grade 3(severe)]and location(lobe,deep,and mixed sites).In addition,we classified cerebral artery stenosis by the degree[no,mild,moderate and severe stenosis(including cerebral artery occlusion)]and location[intracranial artery stenosis(ICAS),extracranial artery stenosis(ECAS)and ICAS and ECAS]of stenosis.The clinical data of patients with different degrees of CMB were compared by univariate analysis and univariate ordinal logistic regression.And the clinical data of patients with CMB at different locations were compared by univariate analysis and comparison between groups.According to the different method of grouping,more detailed analyses were conducted to investigate the correlation between CMB and cerebral stenosis.RESULTS:A total of 512 patients’data were collected.The analysis results are as follows:(1)In this study,the total detection rate of CMB in patients with non-cardiogenic ischemic stroke was 39.26%;109 cases(54.23%)of CMB were found in mixed parts,followed by localized deep parts[56 cases(27.86%)]and lobular distribution[36 cases(17.91%)].(2)Compared with the non-CMB group,the patients in the CMB group were older and have with higher proportion of hypertension,diabetes mellitus,antiplatelet drug application history,WMH and cerebral artery stenosis,while lower level of triglycerides.The difference was statistically significant(P<0.05).Multivariate binary Logistic regression analysis of statistically significant indicators found that age,combined hypertension,history of anti-platelet drug use,severe WMH,and cerebral artery stenosis were independently associated with CMB(P<0.05).(3)Further subgroup analysis was performed on the cerebral artery stenosis between the two groups of patients with CMB and non-CMB.The results showed that there were significant differences in the distribution of cerebral artery stenosis and the degree of cerebral artery stenosis(P=0.012 and P=0.001).Further multivariate binary Logistic regression analysis showed that cerebral artery stenosis(intracranial artery,extracranial artery,coexistence of intracranial artery and intracranial artery)was independently correlated with the occurrence of CMB(all P<0.05).The degree of cerebral artery stenosis was greater than 30%was independently correlated with CMB(P<0.05).(4)Results in groups stratified by the degrees of CMB:(1)The age of patients was statistically different among groups,and further pairwise comparison showed that the level of age in the severe CMB group was higher than that of the mild group(P<0.05).(2)Subgroup analysis was performed on the severity of CMB and the location of cerebral artery stenosis.The results showed that the severity of CMB was independently correlated with intracranial artery stenosis.(3)Subgroup analysis was performed on the severity of CMB and the degree of cerebral artery stenosis,the results showed that the severity of CMB was positively correlated(r_s=0.255,P<0.001);The significant relationship still existed after adjusting all the confounding factors.(5)Results in groups stratified by the distribution of CMB:(1)The prevalence of hypertension in the deep CMB group was higher than that in the lobar group(64.29%vs 36.11%),and the difference was statistically significant.(2)In the three groups,the detection rate of different degrees of cerebral artery stenosis was statistically different.The detection rate of non-cerebral artery stenosis was higher in deep CMB group than that in lobar CMB group(57.14%vs 30.56%);The detection rate of mild cerebral artery stenosis was higher in the lobar CMB group than that in the mixed CMB group(38.89%vs 12.84%);the detection rate of moderate cerebral artery stenosis was higher in the mixed CMB group than that in the deep CMB group(35.78%vs 14.29%).There was no significant difference in the detection rate of severe stenosis of cerebral arteries among the three groups.(3)Subgroup analysis of the correlation between CMB location distribution and cerebral artery stenosis showed that there was no statistical difference between the distribution of CMB and locations of cerebral artery stenosis(P=0.127).Conclusion:Our study showed that patients with non-cardiogenic ischemic stroke have a higher detection rate of CMB.Age,hypertension,history of antiplatelet drug use,severe WMH,intracranial stenosis,and extracranial stenosis were independent risk factors for the occurrence of CMB in patients with non-cardiogenic ischemic stroke.Furtherly,old age was an independent risk factor for the severity of CMB,and hypertension was associated with the occurrence of deep CMB.The severity degree of cerebral artery stenosis was positively correlated with the severity of CMB,among which the moderate and severe cerebral artery stenosis were independent risk factors for the severity of CMB in patients with non-cardiogenic ischemic stroke.The degree of cerebral artery stenosis may affect the distribution of CMB location,and there is no correlation between the location of cerebral artery stenosis and the location of CMB.Exploring the correlation between CMB and cerebral artery stenosis in patients with non-cardiogenic ischemic stroke is of great significance to help clinicians formulate strategies of acute management and secondary prevention for patients,and reduce the risk of stroke recurrence and hemorrhagic transformation.